Two-stage hip resurfacing arthroplasty in a young patient with an infected hip following internal fixation of a complex acetabular fracture

摘要

The two-stage total hip arthroplasty (THA), with or without the use of a cement spacer, is a well described technique that may be employed in the treatment of septic arthritis of the native hip joint or infected hip arthroplasty. A case is presented in which a two-stage hip resurfacing arthroplasty was performed for a case of septic arthritis following internal fixation for a complex acetabular fracture. Case Report A 26-year-old university student sustained an associated both column fracture of his left acetabulum whilst snowboarding in France. Skeletal traction was applied and six days after injury the patient was repatriated to a regional pelvic trauma centre. The fracture was treated with open reduction and internal fixation via a Kocher-Langenbeck approach ten days after injury. This procedure was complicated by a blood transfusion reaction that produced severe cardio-pulmonary compromise requiring intensive care support. As a result of this intra operative deterioration it was not appropriate to proceed to additional anterior plating as had been originally planned.Ten days after surgery, the patient was making a good recovery and was being nursed on the orthopaedic trauma ward. The patient did, however, display persistent pyrexias which prompted a washout of his left hip and deep tissue sampling. These samples grew both Methicillin resistant and Methicillin sensitive Staphylococcus Aureus, and Pseudomonas aeruginosa. On Microbiologist’s advice, a six-week course of intravenous antibiotics (Meropenem and Teicoplanin) was commenced and completed at home. This was followed by a year of oral antibiotics (Rifampicin and Doxycylcine).Two years after the initial injury the patient was suffering with significant pain in the left hip. At this point the patient was referred to our institution. Plain radiographs revealed post-traumatic arthritis of the hip (Figure 1). Figure 1: Pre-operative AP Pelvis Xray