Copper-Coated Spacer for Total Femoral Replacement in Recurrent Periprosthetic Joint Infection: A Case Report

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Abstract

Background. There are few cases of entire femur modular replacement with hip and knee joints in patients with periprosthetic joint infection (PJI) in literature. They report encouraging results in patients of elderly and senile age. We present case of a copper-coated femoral spacer implantation to 50-year-old patient with multiple PJI episodes and osteomyelitis of the entire femur.

Clinical presentation. A 40-year-old male patient after resection of the proximal part of the right femur for fibrotic osteodysplasia underwent total hip arthroplasty with replacement of 15 cm of the femur. In December 2010 (20 months after implantation), instability of the femoral component developed, revision arthroplasty was performed with stem recementation. After 4 months, sinus tract formed in the area of the postoperative scar. After another 4 months, the head of the prosthesis was dislocated. In September 2011, the endoprosthesis components were removed and a unipolar cement spacer was implanted. The limb immobilized in a hip spica cast. Methicillin-sensitive S. epidermidis (MSSE) was detected in the preoperative joint aspiration puncture and periprosthetic tissues. After 3 months (December 2011), patient underwent revision total hip arthroplasty (25 cm defect was replaced). 5 years of PJI remission followed. In November 2016 after PJI recurrence the endoprosthesis was removed, and an articulating spacer was implanted. P. aeruginosa was detected in periprosthetic tissues. For the past 2.5 years there were periodically sinus tracts formations. In August of 2019 spacer’s migration resulted in an intercondylar fracture of the right femur. In September 2019, spacer was removed, and MSSE was detected in the surrounding tissues. An articulating cement spacer based on an oncological modular total femur coppercoated endoprosthesis was implanted. At each control examination during the year copper concentration in blood serum was determined, it did not exceed 900–1200 mcg/l. No local or systemic side effects were detected. The patient started working 3 months after surgery. After 6 months poor functioning sinus tract formed in the postoperative scar area in the lower third of the thigh. 1.5 years after the operation, the functional condition is satisfactory.

Conclusion. The use of the copper-coated spacer based on modular total femur endoprosthesis with hip and knee joints in a patient with multiple PJI allowed to improve the function of the limb and reduce the severity of the infectious process. No local or systemic toxic effects of copper were detected.

About the authors

A. Belokobylov

Nursultan Scientific Research Institute of Traumatology and Orthopedics

Email: baa0711@mail.ru
ORCID iD: 0000-0001-7930-1583

Alexey A. Belokobylov

Nur-Sultan

Kazakhstan

N. D. Batpenov

Nursultan Scientific Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Nurlan D. Batpenov

Nur-Sultan

Kazakhstan

S. S. Balgazarov

Nursultan Scientific Research Institute of Traumatology and Orthopedics

Email: serik.bal@mail.ru
ORCID iD: 0000-0003-4193-7695

Serik S. Balgazarov

Nur-Sultan

Kazakhstan

V. D. Serikbayev

Nursultan Scientific Research Institute of Traumatology and Orthopedics

Email: yese@mail.ru
ORCID iD: 0000-0002-5256-7960

Valeriy D. Serikbayev

Nur-Sultan

Kazakhstan

A. A. Krikliviy

Nursultan Scientific Research Institute of Traumatology and Orthopedics

Email: akriklivyy@list.ru
ORCID iD: 0000-0002-5675-0471

Alexander A. Krikliviy

Nur-Sultan

Kazakhstan

S. V. Plotnikov

East Kazakhstan Technical University

Email: splotnikov@ektu.kz
ORCID iD: 0000-0002-4105-2128

Sergey V. Plotnikov

Ust-Kamenogorsk

Kazakhstan

A. Turlybekuly

Nazarbayev University

Email: aturlybekuly@gmail.com
ORCID iD: 0000-0002-8686-949X

Anamzhol Turlybekuly

Nur-Sultan

Kazakhstan

D. V. Rimashevskiy

RUDN University

Author for correspondence.
Email: drimashe@gmail.com
ORCID iD: 0000-0001-8122-5815

Denis V. Rimashevskiy

Moscow

Russian Federation

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