High-centre total hip arthroplasty with acetabular augment for massive acetabular bone loss following two-stage management of an infected, chondrolysed hip after fracture-dislocation of the acetabulum: a case report

K. Bala Kondaiah; P. Ramanaidu; S. Rajkumar Yadav

doi:10.18203/issn.2455-4510.IntJResOrthop20263958

Authors

K. Bala Kondaiah Department of Orthopaedics, KIMS Hospital, Nellore, Andhra Pradesh, India
P. Ramanaidu Department of Orthopaedics, KIMS Hospital, Nellore, Andhra Pradesh, India
S. Rajkumar Yadav Department of Orthopaedics, KIMS Hospital, Nellore, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263958

Keywords:

Hip fracture-dislocation, Acetabular fracture, Post-surgical hip infection, Femoral head chondrolysis, Girdlestone resection arthroplasty, Antibiotic cement spacer, High hip centre, Total hip arthroplasty

Abstract

Post-traumatic septic arthritis of the hip following surgical fixation of an acetabular fracture is an uncommon but devastating complication that can progress to rapid chondrolysis of the femoral head and, if unchecked, massive acetabular bone loss. Management requires a staged strategy combining infection eradication with later reconstruction. We report a 55-year-old man who sustained a traumatic hip fracture-dislocation with an undisplaced acetabular fracture, initially treated elsewhere with closed reduction followed by open reduction and internal fixation (ORIF) with plating. Three months later he presented with a discharging sinus at the surgical site and radiographic evidence of near-total chondrolysis of the femoral head. He was managed with implant removal, thorough debridement and insertion of antibiotic-loaded cement beads (Girdlestone-type resection arthroplasty), followed by culture-directed systemic antibiotics. Although the infection resolved and the wound healed, the patient remained symptomatic with persistent hip pain. Repeat imaging showed complete loss of the femoral head, proximal femoral migration and near-total acetabular bone loss, confirmed on computed tomography. He subsequently underwent total hip arthroplasty (THA) with a high hip centre construct and an acetabular augment to compensate for the posterior and superior acetabular defect encountered intraoperatively. A staged protocol of aggressive debridement and antibiotic cement spacing, followed by high hip centre THA with augment support, is a viable salvage strategy for infected, chondrolysed hips with severe acetabular bone loss, and can restore a functional, pain-free joint when anatomic reconstruction is not feasible.

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