case_images: PMC10927804_01
case_images: Preoperative x-rays (A,B) and CT scans showing a multi-fragmentary acetabular and femoral head fracture. After septic debridement, removal of remaining foreign bodies and removal of osseous fragments (E), an antibiotic-loaded cemented filler was implanted to the left acetabulum and proximal femur (F).
case_images: fsurg-11-1363298-g001.jpg
case_images: PMC10927804_01_fsurg-11-1363298-g001.jpg
case_images: F1
case_images: Prior to the first surgical intervention, a comprehensive radiographic assessment, including x-ray and CT scans of the pelvis (Figure 1) and a hip joint aspiration (no bacterial growth) were performed.
case_images: Antimicrobial drug therapy over time. p.o. oral application, i.v. intravenous application.
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case_images: PMC10927804_01_fsurg-11-1363298-g002.jpg
case_images: F2
case_images: Antimicrobial therapy with piperacillin-tazobactam and co-trimoxazole was initiated after K. pneumoniae was cultivated from the removed tissue samples by mid-July 2022 (Figure 2). Accordingly, the antimicrobial therapy was changed to cefiderocol, a newly available siderophore cephalosporin (Figure 2). Thus, colistin was added to the ongoing antimicrobial therapy (Figure 2). Hence, daptomycin was added to the cefiderocol and colistin regimen (Figure 2). Therefore, it was decided to start an 3-month oral antimicrobial therapy with doxycycline (Figure 2). Thus, the intravenous antimicrobial therapy with daptomycin was continued during the hospital stay and we decided to initiate an oral therapy with co-trimoxazole until hip arthroplasty (Figure 2). The antimicrobial therapy was continued orally for 6 weeks with Rifampicin and Levofloxacin (Figure 2).
case_images: Pelvic x-rays (A,B) showing the customized cemented filler containing gentamicin, vancomycin and cefiderocol. Foreign body removal was performed before hip arthroplasty implantation (C,D).
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case_images: PMC10927804_01_fsurg-11-1363298-g003.jpg
case_images: F3
case_images: In order to improve the local antimicrobial drug delivery, a drug-eluting customized cemented filler containing gentamicin, vancomycin and cefiderocol was implanted to the left acetabulum und proximal femur (Figures 3A,B). Three months later, the patient was readmitted to our institution for the explantation of the drug-eluting cemented filler and another series of biopsies in order to prepare the left hip for arthroplasty (Figures 3C,D).
case_images: Pelvic x-rays (A,B) illustrating the postoperative result after hip arthroplasty implantation.
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case_images: F4
case_images: Thus, the primary hip arthroplasty, including intraoperative tissue sampling for microbiological analysis, was performed using a trabecular metal shell (TM modular multihole, Zimmer Biomet, Warsaw, Indiana) with an additional screw fixation in predetermined positions to ensure primary shell stability in combination with a meta-diaphyseally anchored hip stem (Smith + Nephew, Watford, UK) (Figure 4).