One-stage revision hip arthroplasty for infection using primary cementless stems as first-line implants: About 35 cases.

INTRODUCTION: During infected total hip arthroplasty revisions (THAR), the need for systematic antibiotic cementation remains undefined. HYPOTHESIS: Implantation of a primary cementless stem as first-line implant in 1-stage septic THAR provides results as good as those from a stem cemented with antibiotics in terms of infection resolution. MATERIALS AND METHODS: We retrospectively examined 35 patients operated on for septic THAR with Avenir® cementless stem placement - between 2008 and 2018 at Besançon University Hospital - with a minimum follow-up of 2 years to define healing in the absence of infectious recurrence. Clinical outcomes were assessed using the Harris, Oxford, and Merle D'Aubigné scores. Osseointegration was analyzed by the Engh radiographic score. RESULTS: The median follow-up was 5±2.6 years (2-11). The infection was cured in 32 of 35 (91.4%) patients. The median scores of the following were: Harris 77/100, Oxford 47.5/60 and Merle d'Aubigné 15/18. Of 32 femoral stems, 31 (96.8%) had radiographically stable osseointegration. Age greater than 80 years was a risk factor for failure to cure the infection during septic THAR. DISCUSSION: A primary cementless stem as first-line implant plays a role in 1-stage septic THAR. It confers good results in terms of infection resolution and stem integration in the setting of loss of femoral bone substances rated Paprosky 1. LEVEL OF EVIDENCE: IV; retrospective case series.

Omentum Free Flap Anastomosed to Arterial Bypass in Open Knee Dislocation: Case Report and Discussion.

OBJECTIVE: To report on the original surgical management of a patient with severe trauma of both legs involving anastomosis of an omentum free flap with an emergency vascular bypass. METHODS: After stabilization of the knee with an external fixator, a femoral-tibial bypass graft was performed to revascularize the leg with the contralateral great saphenous vein. Ten days later, an omentum free flap was used with an end-to-side arterial anastomosis between the right gastroepiploic artery and bypass graft to cover the loss of leg substance. DISCUSSION: Anastomosis of a free flap with a single axis exposes the patient to risks of thrombosis and amputation. Lengthening of the arterial pedicle of the flap by venous graft or vascular loop might have allowed for avoidance of connection to the bypass. Nevertheless, the saphenous vein, generally used in these indications, was already harvested. The transitional anastomosis of the flap to the contralateral leg could not be considered because of the leg amputation. End-to-side anastomosis to the bypass presents many advantages: anastomosis with a healthy vessel without posttraumatic vascular disease, the superficial characteristics of the bypass, and lower incongruence of the thickness between the vessels compared with an anastomosis performed directly on the superficial femoral artery. CONCLUSION: A free flap anastomosed to an emergency arterial bypass is a rare situation, which is not without risk, but it is an option that is justified by its technical simplicity. However, it should only be considered in exceptional circumstances.