J Korean Orthop Assoc.  2009 Feb;44(1):14-21. 10.4055/jkoa.2009.44.1.14.

Advantages of PROSTALAC Prepared by Modified Cement-coating Method

• Nam DC
• Hwang DS
• Lee HJ

• KMID: 2186373
• DOI: http://doi.org/10.4055/jkoa.2009.44.1.14

Abstract

PURPOSE: To report the clinical advantage and effect of our modified cement-coating method of PROSTALAC for the treatment of infected hip arthroplasty.
MATERIALS AND METHODS
Twenty seven patients (mean age, 57), who had been treated with PROSTALAC after an infected hip arthroplasty, were enrolled in this study. Before surgery, the femoral stem was sterilized with gamma-radiation. During the operation, the stem was coated with antibiotics-impregnated cement and introduced into the femoral canal by several repeats of an insertion and removal procedure, just like a piston movement, to fit the stem into the intramedullary canal space. A bipolar hemiarthroplastic polyethylene liner was used for acetabular cup cement-fixation. A periodic hematologic test, such as ESR and CRP, the ability of early ambulation, leg length discrepancy and hip flexion, were checked for the clinical evaluation.
RESULTS
CRP was normalized by an average of 4.2 weeks after the PROSTALAC operation. Partial weight bearing was possible 2 weeks after surgery, and mean leg length discrepancy and flexion of hip was 1.4 cm and 63.5degrees, respectively. PROSTALAC was still retained in 5 cases with satisfactory function. Reinfection after final reimplantation (22 cases) was noted in 4 cases (18.2%). Neither dislocation nor periprosthetic fracture occurred after reimplantation.
CONCLUSION
The 2 phase treatment with PROSTALAC is an effective method for infected hip arthroplasty. PROSTALAC has considerable benefit for providing daily acting ability before the final reimplantation provided the appropriate surgical technique and strict sterilization of the inserted implements are combined.

Keyword

Infected hip arthroplasty; Piston movement; Modified cement-coating method; PROSTALAC

MeSH Terms

Arthroplasty
Dislocations
Early Ambulation
Hematologic Tests
Hip
Humans
Imidazoles
Leg
Nitro Compounds
Periprosthetic Fractures
Polyethylene
Replantation
Sterilization
Weight-Bearing
Imidazoles
Nitro Compounds
Polyethylene

Figure

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  Fig. 1 (A) Photograph showing the simple locking mechanism, as the polyethylene liner was used for bipolar hemiarthroplasty, by tightening the liner with a wire before the cement fixation to the acetabulum in order to prevent the postoperative dislocation. (B) Photograph after the cement fixation to the acetabulum.

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  Fig. 2 (A) Preoperative radiograph of a 76-year-old male patient who was diagnosed with an infective total hip arthroplasty. (B) Radiograph at 2 years after PROSTALAC spacer insertion. (C) Although infective condition was controlled, the spacer was still retained in the hip joint 5 years after surgery.

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