Analysis of Failed Two-Stage Procedures with Resection Arthroplasty as the First Stage in Periprosthetic Hip Joint Infections

Resection arthroplasty can be performed as the first stage of a two-stage procedure in some patients with severe periprosthetic hip joint infections with poor bone stock. This retrospective study aimed to evaluate factors associated with the subsequent failure or success of these patients. Between 2011 and 2020; in 61 (26.4%) of 231 patients who underwent a two-stage protocol of periprosthetic hip joint infections; no spacer was used in the first stage. The minimum follow-up period was 12 months. Patient’s demographics and various infection risk factors were analyzed. In total, 37/61 (60.7%) patients underwent a successful reimplantation, and four patients died within the follow-up period. Patients within the failure group had a significantly higher Charlson comorbidity index (p = 0.002); number of operations prior to resection arthroplasty (p = 0.022) and were older (p = 0.018). Failure was also associated with the presence of a positive culture in the first- and second-stage procedures (p = 0.012). Additional risk factors were persistent high postoperative CRP values and the requirement of a negative-pressure wound therapy (p ≤ 0.05). In conclusion, multiple factors need to be evaluated when trying to predict the outcome of patients undergoing resection arthroplasty as the first stage of a two-stage procedure in patients with challenging periprosthetic hip joint infections.

The programme of comprehensive rehabilitation after LUMIC post-resection with the reconstruction of a proximal part of femur with MUTARS system resulting from the treatment of pelvis chondrosarcoma.

Introduction: Malignant neoplasms of bone originating from the supporting tissues of the body of mesinchymal origin are heterogeneous in clinical and histological terms. In most cases, the etiology of these tumors is unknown. Histologically, sarcomas are classified into three main types. Chondrosarcoma (31% of sarcomas), osteosarcoma - originating from bone tissue (also accounts for 31% of sarcomas), Ewing sarcoma - originating from neuroectodermal tissue (accounts for 14% of sarcomas). The aim of this study was to present a program of comprehensive rehabilitation after LUMIC resection arthroplasty with reconstruction of the proximal part of the femur using the Mutars system as a result of pelvic chondrosarcoma treatment. Materials and methods: The paper describes a case of a patient diagnosed with left pelvic chondrosarcoma with a pathological fracture and destruction of the left hip joint. Results: In the rehabilitation program, both inpatient and outpatient, many methods of therapy have been used in order to restore the patient to the highest possible fitness as quickly as possible. The therapy was based on such exercises and methods as: PNF method, methods of visceral therapy, active exercises and methods of osteopathy. Conclusion: Rehabilitation is an indispensable element of the treatment of cancer patients. The introduction of modern techniques, such as manual therapy and osteopathy to rehabilitation, has a positive effect on the effectiveness of therapy.