Staged Revision of a Chronic Infected Ipsilateral THA and TKA Using an Antibiotic Laden PMMA Functional Spacer Incorporating a Knee Fusion Nail

This case involved an elderly man with a failed infected total hip replacement (THA), massive acetabular and femoral bone loss, and extension of the infection to involve his native degenerative knee. This ultimately required radical debridement with removal of the entire femur, all the components, and prior polymethyl methacrylate (PMMA). The challenge was to construct a temporizing functional PMMA spacer that would simultaneously replace a completely resected femur, act as a functional articulating device at the hip, and allow immediate weight bearing to restore mobility during the interim between the two stages. Staged reconstruction was made possible using an interim custom antibiotic-impregnated PMMA spacer incorporating a THA stem impaled on a knee fusion intramedullary (IM) nail.