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Two-stage revision arthroplasty is the gold standard for treatment of infection after total hipArthroplasty and end stage septic arthritis of the hip. In the first stage we used a modifiedtechnique to insert an inexpensive modular femoral component coated with antibioticimpregnatedpolymethylmethacrylate articulating with a polyethylene liner. The construct wasused in 8 patients with infected arthroplasty, and 6 patients with septic arthritis of the hip. Twopatients were excluded (no second stage). Of the remaining 12 patients, only one patient hadpersistent infection after the first stage; 11 patients received a successful re-implantation at thesecond-stage. The technique provide a construct that can be used safely and successfully in theawaiting period between the two stages of revision arthroplasty. Key words: functionaltemporary prosthesis, infection, arthroplasty, two-stage, septic hipIntroductionSepsis after total hip arthroplasty (THA) is a potentially devastating complication that mayresult in major morbidity for the patient and adversely affecting the functional outcome. Furtheroperations are usually required to control the sepsis which, despite the best efforts, canultimately end in a disfiguring result. Different treatment strategies that have been employed toclear infection and leave the patient with a functioning joint include: Antibiotic treatment aloneresulting in resolution of infection (rarely achieved); prolonged suppressive antibiotics withoutremoving the components (useful in the generally infirm with well-fixed components, highlysensitive organisms, and no systemic sepsis [1]); surgical debridement with retention of theoriginal prosthesis (in early infection); one-stage exchange arthroplasty; two-stage exchangewith or without a temporary spacer.Sepsis in the adult native hip is an uncommon problem that has an increased incidence in theelderly and immune-compromised population with chronic diseases, with haematogenousspread is the most common route of infection. Patients with diabetes mellitus, cirrhosis, endstagerenal disease, systemic lupus erythematosus, (SLE), rheumatoid arthritis have abnormalwhite blood cell (WBC) response, decreased complement and antibody function, and immunesystem dysfunction. Patients with local articular disorders like osteoarthritis, avascular necrosis(AVN), previous trauma have alteration of the normal joint environment interrupting theexchange process of nutrients and waste, increase in synovial permeability allowing bacterialinvasion. Pyogenic arthritis and sepsis in an arthritic joint can pose difficult managementproblems since the risk of infection after total hip arthroplasty is very high. Treatmentmodalities for patients with end-stage septic arthritis include: debridement and fusion, resectionfile:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]