Background
Infections in prosthetic joints are an uncommon (but disastrous) complication of arthroplasty. Infections associated with hemiarthroplasty for intracapsular fractures of the femoral neck can be fatal.1
Polymethylacrylate cement can be used to deliver antibiotics directly to an area of infection, thereby reducing the need for long-term administration of antibiotics.2 This method is used commonly in twostage revision arthroplasty for infected total hip replacements.
Technique
During washout for suspected infection of a prosthetic joint after modular hemiarthoplasty (Exeter Unitrax®; Styker, Kalamazoo, MI, USA; Fig 1a), the head component is removed, followed by sampling for microbiology and pulse lavage. Foam from the packaging is placed into the collar insert (Fig 1b). Antibiotic-loaded cement is prepared without use of a vacuum to allow optimum elution of the antibiotic.3 This cement is inserted into the space between the collar insertion and inner surface of the head using a McDonald elevator. The cement is allowed to set, the foam insert is removed, and the head replaced.
Figure 1.
Introduction of antibiotic-loaded cement using the Exeter Unitrax® system (Stryker)
This technique allows delivery of antibiotics directly around the prosthesis, as well as removing a potential space for collection of debris and microbial colonisation.
Discussion
In cases of suspected infected hemiarthoplasty, introduction of additional antibiotic-loaded cement at the time of washout may be desirable compared with revision procedures. The aim is to reduce the systemic load of antibiotics, remove dead space for biofilm formation, and prevent the need for full revision surgery.4
References
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