Author(s): *Zalavras C.G., Zahos K.A., Holtom P.D., Patzakis M.J.; LAC+USC Medical Center, Los Angeles,CA
Title: Excision arthroplasty for the definitive treatment of femoral head osteomyelitis
Purpose: The purpose of this study was to evaluate excision arthroplasty as the definitive treatment for the challenging problem of hip sepsis with osteomyelitis of the femoral head.
Methods: This retrospective study included 14 consecutive patients (10 male, 4 female, mean age 48years) who underwent excision arthroplasty as the definitive management for femoral head osteomyelitis in the absence of implanted hardware. Thirteen patients (93%) were compromised hosts and the most common comorbidity was intravenous drug abuse (n=8). Staphylococcus aureus was cultured in 8 patients and was oxacillin-resistant in 5 of these. All procedures were performed by a single surgeon (CGZ) with a consistent protocol and antibiotics were administered for 6 weeks postoperatively.
Results: The median follow-up was 6 months (range, 2 to 35 months). Infection was controlled in all cases with no recurrence. Pain was relieved completely in eight patients; mild pain on walking was present in 5 and moderate pain persisted in one patient. Shortening of the involved lower extremity ranged from 4 to 7 cm. All but one patient were able to ambulate with use of an assistive device (cane or walker). Discussion Hip arthroplasty in the setting of previous hip infection carries increased risk of re-infection, especially in patients with comorbidities. Excision arthroplasty controls infection, allows ambulation, and is a viable alternative for the management of hip sepsis with osteomyelitis of the femoral head in compromised hosts.
