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arthroplasty, and reconstruction with a total joint arthroplasty after resolution of the infection ina two-stage procedure.In this study, we introduce a modified technique of two-stage arthroplasty for the managementof patients with infected hip arthroplasty, and end stage septic arthritis of the hip.Materials and MethodsA prospective study was conducted using the construct resulting from this modified technique.Data about each patient was documented and recorded onto case report forms. Data includedpatient’s demographic data, medical history, index operation diagnoses, Harris Hip Score (HHS)before first stage, postoperative courses, HHS after second stage. Patients were included in theprospective study population if they met the following criteria: (1) end stage arthritis with hipinfection was confirmed or suspected; (2) the patient had infection following total hipreplacement, or hemiarthroplasty. Diagnosis of infection was suspected through patient’smedical history, risk factors for infection, and whether there were wound complications in thepostoperative period following the index operation in arthroplasty cases, clinical examinationfor discharging sinuses, laboratory investigations including elevated white blood cell count,ESR, C-reactive protein (CRP). Hip aspiration was performed under sterile condition prior tothe first stage surgery at least 4 weeks after cessation of all antibiotic therapy for culture andcytological analysis with WBC over 25,000 and a differential count of over 25%polymorphonuclear leukocytes, low glucose and high protein levels is highly suggestive ofinfection[2].Patient is positioned in the true lateral position. Direct lateral approach was used in all cases. Ininfected arthroplasty cases the cemented femoral stem was loose and removed with minimal orno difficulty; the difficulty mostly came with cement removal due to strong interdigitation at thebone-cement interface. Cement is then removed antegrade and completed with ‘’scaphoidosteotomy technique’’, where a carefully planned osteotomy of the anterolateral cortex of thefemur is performed starting at the site of the distal plug and extending for 8cm proximal withrounded corners to minimize stress raisers to remove distal plug and the remaining cement. Atthe completion of the procedure, the osteotomy is fixed with cerclage wires. The acetabularcomponents were easier to remove. Meticulous debridement and intraoperative tissue biopsy istaken (at least 3 specimens from each side) then follows the removal of the components. Thetemporary functional hip prosthesis consists of a standard polyethylene liner, and anfile:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]