Two-stage treatment of hip periprosthetic joint infection complicated with retroperitoneal urinary bladder defect
Abstract. Purpose To demonstrate the need for a multidisciplinary approach to the treatment of patients with deep periprosthetic joint infection (PJI) and emphasize the importance of preoperative preparation and well-coordinated work of related specialists using a specific clinical instance. Case r...
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| Autores principales: | , , , , |
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| Formato: | article |
| Lenguaje: | EN RU |
| Publicado: |
Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
2021
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/a75a655ee5dc4e859d7ce2bf87c49b83 |
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| Sumario: | Abstract. Purpose To demonstrate the need for a multidisciplinary approach to the treatment of patients with deep periprosthetic joint infection (PJI) and
emphasize the importance of preoperative preparation and well-coordinated work of related specialists using a specific clinical instance. Case report Reported
is a successful experience of two-stage treatment of the patient with hip PJI complicated with urinary bladder defect. A 40-year old male patient diagnosed
with left-sided deep hip PJI Tsukayama type 3 was treated at department of infection surgery, Rostov Regional Clinical Hospital No. 2 in January 2019. Total
hip arthroplasty performed in 2008 was complicated by migration of acetabulum component. A retroperitoneal bladder defect (pressure ulcer) was detected
during the first stage of resection arthroplasty and placement of an antibacterial spacer. Urological procedure was performed in a delayed manner due to
technical difficulties of implant removal, prolonged and traumatic procedure, and high blood loss. With the patient's condition stabilized cystoscopy and
bilateral ultrasound guided percutaneous nephroureterostomy were performed. Prolonged antibacterial aetiotropic treatment was administered. The second
stage of surgical treatment included revision hip arthroplasty using a tailored acetabular component and a standard revision femoral component performed
at 6 months of debridement. Results Short- and long-term results were good with sustained remission achieved. Patient could walk unassisted using a cane
and had a satisfactory ROM in the left hip with HHS scored 76.255. Conclusion Multiple disciplinary teamwork is appropriate for treatment of deep PJI
with much coherence, coordinated efforts and expertise from diverse professionals. |
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