1. Primary Total Hip Arthroplasty After Infection
by G. M. Robbins, B. A. Masri, D. S. Garbuz, and C. P. Duncan
J Bone Joint Surg Am
Volume 83(4):
April 1, 2001
©2001 by The Journal of Bone and Joint Surgery, Inc.

2. The authors’ preferred algorithm for the late management of septic arthritis of the hip.
The authors’ preferred algorithm for the late management of septic arthritis of the hip. ESR = erythrocyte sedimentation rate, CRP = level of C-reactive protein, MDP = methylene diphosphonate, and WBC = white blood cell.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.

3. The prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is a temporary functional spacer that may be used within the hip joint space after a resection arthroplasty that is performed for the treatment of infection or at the site of a total hip arthrop...
The prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is a temporary functional spacer that may be used within the hip joint space after a resection arthroplasty that is performed for the treatment of infection or at the site of a total hip arthroplasty. It may be used instead of antibiotic-loaded cement beads not only to act as an antibiotic depot but also to maintain the soft-tissue space within the hip joint and to allow good function while the patient is awaiting definitive hip arthroplasty.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.

4. This patient presented with acute onset of pain in the hip.
This patient presented with acute onset of pain in the hip. The diagnosis of septic arthritis of the hip was missed, and he was not seen again for treatment until a few months after the onset of symptoms. Because of marked and rapid destruction of the joint, septic arthritis of the hip was suspected. The erythrocyte sedimentation rate and the level of C-reactive protein were both elevated, and an aspiration biopsy allowed the identification of Staphylococcus aureus as the infecting organism.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.

5. Fig. 3-B Because of the presence of active infection at the time of diagnosis, immediate hip replacement was contraindicated, and a staged approach was chosen.
Fig. 3-B Because of the presence of active infection at the time of diagnosis, immediate hip replacement was contraindicated, and a staged approach was chosen. The prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is shown in situ as a temporary spacer.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.

6. Fig. 3-C Following a six-week course of intravenous antibiotics, the patient was observed for another six weeks to ensure that the infection was under control.
Fig. 3-C Following a six-week course of intravenous antibiotics, the patient was observed for another six weeks to ensure that the infection was under control. A definitive hip replacement with antibiotic-loaded cement was performed three months after the initial operation.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.

7. Fig. 4-A This fifty-eight-year-old patient, who was a known intravenous drug abuser, presented with septic arthritis of the hip.
Fig. 4-A This fifty-eight-year-old patient, who was a known intravenous drug abuser, presented with septic arthritis of the hip. He was treated with an arthrotomy, incision and drainage, and six weeks of intravenous antibiotics. He was subsequently referred for a hip replacement. Because of concerns regarding his ongoing intravenous drug abuse, a Girdlestone resection arthroplasty was performed and an antibiotic-loaded cement spacer was used. Subsequently, the patient underwent a pneumonectomy for a low-grade lung carcinoma and, during the course of treatment, he received inpatient rehabilitation for his heroin addiction.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.

8. Fig. 4-B Because of ongoing disability, the patient underwent a definitive hip replacement two years later.
Fig. 4-B Because of ongoing disability, the patient underwent a definitive hip replacement two years later. The stem was inserted with antibiotic-loaded bone cement. At the last follow-up examination (one year postoperatively), there was no evidence of ongoing infection.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.

9. This patient presented ten days following the onset of severe hip pain.
This patient presented ten days following the onset of severe hip pain. Septic arthritis of the hip was diagnosed. Advanced joint destruction had already been noted on the preoperative radiographs.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.

10. Fig. 5-B A hip replacement was performed in two stages.
Fig. 5-B A hip replacement was performed in two stages. In the first stage, the hip was debrided and the femoral head was resurfaced with a thin layer of antibiotic-loaded bone cement.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.

11. Fig. 5-C Following a six-week course of intravenous antibiotics, the patient was observed for another six weeks to ensure that the infection was under control.
Fig. 5-C Following a six-week course of intravenous antibiotics, the patient was observed for another six weeks to ensure that the infection was under control. A definitive hip replacement with antibiotic-loaded cement was performed three months after the initial operation.
G. M. Robbins et al. J Bone Joint Surg Am 2001;83:601
©2001 by The Journal of Bone and Joint Surgery, Inc.