Decision Making in A Complex Revision Total Hip


David Rothem 1,2 Hussain Shehade 2 Alexander Lerner 1,2
1Bar Ilan University, Faculty of Medicine, Zefat, Israel
2Orthopaedic Department, Ziv Medical Center, Zefat, Israel

We present a rare case of an immunocompetent host who developed a candida glabata infected total hip prosthesis.

A 53 years old woman had total hip replacement duo to DDH 21 years ago and 4 revisions later. The last revision was 3 years earlier to her admission because of an acetabular component loosening. She had a painful limp; she needed the aid of two crutches for walking. Her preoperative work up reviled Candida glabata infection, loosening of the acetabular component with massive bone lost at her acetabulum and absent of the proximal femur.

We conducted two stage revisions, with long term anti-fungal treatment and functional cement spacer with imbedded antifungal drug until eradication was achieved 4 months post-surgery by laboratory tests and negative cultures.

We conducted the second stage revision using patient-matched prosthesis for the acetabular component and replaced the proximal femur with allograft on the femoral side.

She is two years post revision. She is pain free walking with one crutch duo to trendelenburg gait. On her laboratory tests and X-ray there is no signs of infection or any other complication.