IMPLANT REMOVAL AND ANTIBIOTIC CEMENT SPACER FOR PROSTHETIC JOINT INFECTION FOLLOWING TOTAL HIP ARTHROPLASTY: A CASE REPORT

Abstract

Background- Periprosthetic joint infection (PJI) is among the most challenging complications following total hip arthroplasty (THA), accounting for significant morbidity, repeated surgeries, prolonged hospitalization, and increased healthcare costs. The diagnosis of chronic PJI requires integration of clinical findings, laboratory parameters, imaging, and histopathological evidence. Two-stage revision arthroplasty remains the preferred treatment strategy for chronic infections. Case Presentation- A 71-year-old female presented with a two-month history of progressive pain and swelling over the left hip. She had undergone left hemiarthroplasty 18 years earlier, conversion to total hip replacement 16 years earlier, and wound debridement with sinus tract excision in 2022. Clinical examination revealed a fluctuant, tender swelling over the greater trochanter with painful restriction of hip movements. Laboratory investigations showed elevated inflammatory markers (ESR 85 mm/hr, CRP 3.3 mg/dL) with mild leukocytosis (10,600 cells/µL). Synovial fluid analysis was suggestive of infection, and PET-CT demonstrated metabolically active peri-prosthetic collections consistent with chronic prosthetic joint infection. The patient underwent implant explantation, thorough debridement, insertion of an antibiotic loaded cement spacer, and placement of antibiotic-loaded calcium sulphate (Stimulant®) beads. Histopathological examination confirmed chronic prosthetic joint infection with acute suppurative inflammation. Conclusion- Early diagnosis using a multimodal approach and timely surgical intervention with staged revision remain essential for successful management of chronic prosthetic joint infection following total hip arthroplasty.