Cement-a-TAN Temporary Proximal Femoral Replacement for Staged Joint Replacement - A Case Report.

ABSTRACT

INTRODUCTION: Infected non-unions of proximal femoral fractures are difficult to treat. If debridement and revision fixation is unsuccessful, staged revision arthroplasty may be required. Non-viable tissue must be resected; coupled with the introduction of an antibiotic-eluting temporary spacer before definitive reconstruction. Tissue microbiological diagnosis and targeted antibiotic therapy are required. In cases of significant proximal femoral bone loss, spacing options are limited. CASE REPORT We present a case of a bisphosphonate-induced subtrochanteric fracture that progressed to infected non-union. Despite multiple washouts and two revision fixations, the infection remained active with an unfavorable antibiogram. The patient required staged revision arthroplasty including a proximal femoral resection. To improve function through maintaining leg length and offset, the Cement-a-TAN was fabricated. It is a custom-made antibiotic-eluting articulating temporary spacer. Using a trochanteric entry cephalocondylar nail as a scaffold, bone cement was molded around the nail to fashion an anatomical and patient-specific proximal femoral spacer. Following resolution of the infection, the Cement-a-TAN was removed and a proximal femoral arthroplasty was successfully performed. CONCLUSION: Cement-a-TAN is an excellent temporary spacing technique in staged proximal femoral replacement for infected non-union of the proximal femur where there has been significant bone loss. It preserves mobility and maintains leg length, offset, and periarticular soft-tissue tension, while offering good stability.