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Background: The role of the synovial biopsy in the preoperative diagnosis of a periprosthetic joint infection (PJI) of the hip has not been clearly defined., Questions/purposes: We asked whether the value of a biopsy for a PJI is greater than that of aspiration and C-reactive protein (CRP)., Methods: Before revision in 100 hip endoprostheses, we obtained CRP values, aspirated the joint, and obtained five synovial biopsy samples for bacteriologic analysis and five for histologic analysis. Microbiologic and histologic analyses of the periprosthetic tissue during revision surgery were used to verify the results of the preoperative diagnostic methods. The minimum followup was 24 months (median 32; range, 24-47 months)., Results: Forty-five of the 100 prostheses were identified as infected. The biopsy, with a combination of the bacteriologic and histologic examinations, showed the greatest diagnostic value of all the diagnostic procedures and led to a sensitivity of 82% (95% CI, ± 11%), specificity of 98% (95% CI, ± 4%), positive predictive value of 97% (95% CI, ± 5%), negative predictive value of 87% (95% CI, ± 8.3%), and accuracy of 91%., Conclusions: The biopsy technique has a greater value than aspiration and CRP in the diagnosis of PJI of the hip (Masri et al. J Arthroplasty 22:72-78, 2007). In patients with a negative aspirate, but increased CRP or clinical signs of infection, we regard biopsy to be preferable to just repeating the aspiration., Level of Evidence: Level II prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

A prospective study of 15 patients was designed to examine whether the modular cementless revision stem (Revitan curved; Zimmer GmbH, Winterthur, Switzerland) is suitable for stem revisions with a defective isthmus when distal interlocking screws are also used for fixation. During a follow-up period of 35.4 +/- 11.4 months (24-70 months), there was one stem loosening with screw breakage in a case of a stem that was too thin. According to Engh et al, bony ingrowth fixation of the stem occurred in 12 cases and stable fibrous fixation in 2 cases. The Harris Hip Score rose continuously from 44.7 +/- 12.9 points preoperatively to 75 +/- 10 points at 24 months. This concept of additional stem fixation with distal interlocking screws represents a useful treatment option for revision arthroplasty in rare cases of a defective isthmus., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Unlabelled: Cementless two-stage revision of infected total hip prostheses lacks the possibility of local antibiotic protection of the implant at the time of reimplantation, which leads to the concern that this protocol may not sufficiently eradicate periprosthetic infection. Moreover, early implant loosening as much as 18% and stem subsidence as much as 30% have been reported. To determine whether a cementless revision could eradicate infection and achieve sufficient implant stability, we prospectively followed 36 patients with two-stage revisions for septic hip prostheses. We used a uniform protocol of a 6-week spacer interval, specific local and systemic antibiotic therapies, and cementless modular revision stems. The minimum followup was 24 months (mean, 35 months; range, 24-60 months). In one patient, the spacer was changed when the C-reactive protein value failed to normalize after 6 weeks, and the reimplantation was performed after an additional 6 weeks. No infections recurred. There was no implant loosening and a 94% bone-ingrowth fixation of stems. Subsidence occurred in two patients. The Harris hip score increased from a preoperative mean of 41 to 90 at 12 months after reimplantation and later. Using cementless prostheses in two-stage revisions of periprosthetic infections of the hip in combination with a specific local and systemic antibiotic therapy seems to eradicate infection and provide implant stability., Level of Evidence: Level IV, therapeutic study.

Introduction: A prospective study was designed to test the hypothesis that short-term results after hip revisions are in association with the surgical approach with lower clinical scores for the transfemoral approach., Materials and Methods: A total of 120 hip revision operations with the modular cementless revision stem "Revitan Curved" (Zimmer GmbH, Winterthur, Switzerland), of which 42 replacements involved an endofemoral (posterolateral) approach and 78 implantations a transfemoral approach, were followed up over a period of at least 24 months., Results: In the early post-operative stage, stems implanted transfemoral were associated with significantly lower Harris Hip Scores and a significantly more frequent appearance of Trendelenburg signs. The differences lessened at the end of the follow-up period. Within the group of transfemoral implantation, all six stems with a circular fixation zone measuring less than 3 cm had subsided and two of these had become loose; none of the stems with greater fixation zones exhibited these properties. In the case of the endofemoral implants, three stems exhibited sinking but there did not appear to be any relationship between this event and length of fixation zone., Conclusion: The surgical approach has an association with the short-time outcomes of hip revsions using cementless modular stems. Transfemoral implantation of the "Revitan curved" stem requires a fixation zone of at least 3 cm and a longer period of rehabilitation.

The transfemoral approach in its traditional form, using a nonmodular Wagner self-locking revision stem, has the disadvantages of a less predictable union rate of the bony flap and a high rate of stem subsidence. To investigate whether this situation can be improved by using a modified transfemoral approach and modular curved cementless revision stems, we prospectively analyzed 68 hip revisions and followed them clinically and radiographically for a minimum of 24 months (mean +/- standard deviation, 32.4 +/- 11.2 months). One year after the operation, the osteotomy showed bony consolidation in all but one case (98.5%). We noted subsidence in six cases (8.8%) and two of these stems became loose. In all of these cases, the circular fixation zone of the stem in the isthmus of the femur was less than 3 cm. The Harris hip score improved continuously from 41.4 +/- 14.5 points preoperatively to 85.9 +/- 14.6 points 24 months postoperatively. The modified transfemoral approach in combination with a curved, modular revision stem showed reproducibly good results concerning union of the bony flap and subsidence of the stem if the fixation zone was not less than 3 cm.

The nature of the treatment of periprosthetic fractures depends on the localisation, the stability of the prosthesis and the condition of the bone. The Vancouver fracture classification has proved to be of value in determining specific modes of treatment. The current review analyses the different therapeutic options resulting in a concept of fracture-specific treatment. In this report we propose an extended version of this classification in which periprosthetic fractures associated with endoprostheses anchored in the epiphysis or metaphysis, as well as interprosthetic fractures, are taken into consideration.