PMC5481614_01
Pelvic x-ray showing the retained femoral stem prior to the second revision.
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F4
Intraoperatively, a periprosthetic fracture occurred while attempting to remove the well-fixed stem (Fig. 4).
Postoperative X-rays showing the temporary antibiotic spacer construct. Note the antibiotic cement does not surround the nail within the bone, as opposed to a pre-constructed antibiotic nail.
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F5
The patient had debridement and excision of the proximal femur as per this described technique (Fig. 5).
CRP trend in the pre and post operative period.
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F6
The inflammatory markers subsequently normalized (Fig. 6).
Definitive reconstruction with proximal femoral replacement and cone pelvis reconstruction.
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F7
After a 3 month period, 6 weeks of which outpatient intravenous antibiotics were given, the definitive reconstruction with a cone hemipelvis and proximal femoral replacement was performed (Fig. 7).
PMC5481614_02
X-ray and MRI showing pathological fracture with involvement of proximal femoral diaphysis.
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F8
A 71-year old female presented with a pathologic intracapsular fracture of the left proximal femur (Fig. 8) which was diagnosed as a primary diffuse large B-cell lymphoma amenable to curative therapy.
Proximal femoral replacement as management of the pathological fracture.
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F9
A proximal femoral resection and replacement with a bipolar head was performed (Fig. 9).
Postoperative x-ray following 1st stage revision.
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F10
Despite an irrigation and debridement, her symptoms persisted and a two-stage revision was performed using the described technique (Fig. 10).
X-ray 3 years following 2nd stage revision with no evidence of loosening and signs of bone integration onto the prosthesis.
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F11
A silver-coated proximal femoral replacement was implanted 3 months later after normalization of inflammatory markers and withdrawal of antibiotics (Fig. 11).
PMC5481614_03
Preoperative MRI and postoperative x-ray of the pleomorphic sarcoma reconstructed with a coned pelvis.
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F12
This was curatively excised with extra-articular resection and reconstructed with a coned pelvis with a subsequent unremarkable recovery (Fig. 12).
Post operative x-ray of femoral spacer. Note long segment of nail buried into void from previous femoral component stem and preservation of coned pelvis.
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F13
The patient had the first stage of his revision completed (Fig. 13).