Management and results in 16 cases of periprosthetic fracture and infection after hip and knee arthroplasty. Experience in 2005-2015

Introduction. Periprosthetic fracture (PPF) with periprosthetic joint infection (PJI) is a serious complication of both total hip replacement (THR) and total knee artthoplasty (TKA). Materials and methods. Results were evaluated in 16 patients (17 prostheses) aged 35-82 years, operated due to infection and fracture after THR (8) and TKA (9). Observation period 3-13 years (average 6.5 years). Etiology of infection: S. aureus (11), Staph. epidermidis (3), VRE (1), Pseudomonas aeruginosa (1), E. Coli (1). Fractures have been stabilised with: cerclage, Partridge tapes, Bridgeplate system with acrylic cement with antibiotic (ALAC), 1-2 plates with screws, cerclage and nail with ALAC (2), Integracja plate, femoro-tibial nail with ALAC spacer as knee arthrodesis, intramedullary ALAC spacer constructed on a nail. There have been performed THR and TKA revisions: 2-stage (8), 1-stage (1), definitive removal of prosthesis (5), spacer without reaimplantation (1), debridement (1), conversion of the total femoral prosthesis into a permanent total femoral ALAC spacer (1). Results. Cure of infection in 12 and fracture healing was achieved in 9 patients. There were performed 2 amputations. 10 prostheses were preserved and 5 were removed. Limb function after treatment: very good (1), good (7), sufficient (6), bad - after amputation (2). Conclusions. In each case of fracture and infection, apart from the fixation of the fracture, revision of the endoprosthesis should be performed, using a spacer or local carriers of antibiotics near the endoprosthesis and fracture ostheosynthesis. A stable fixation of fracture with plate, intramedullary nail or spacer with stem is necessary to get union and cure the infection. In infected periprosthetic fractures with unstable endoprosthesis, good conditions for fracture healing and cure of infection can be obtained by using a spacer extended with a long intramedullary stem covered with ALAC with a 5% addition of a targeted antibiotic.