case_images: PMC6540491_01
case_images: Radiographic images of patient 1 presenting radiographs (A&B), interval placement of MAAS (C), and final reconstruction completed using a combination of femoral allograft, intramedullary nail, and bridging lateral locking plate (D).
case_images: 10.1177_2151459319847399-fig2.jpg
case_images: PMC6540491_01_10.1177_2151459319847399-fig2.jpg
case_images: fig2-2151459319847399
case_images: On initial presentation, the patient had loose-appearing femoral stem with severe osteolysis (Figure 2A). After preoperative medical optimization, the patient underwent resection of proximal femur down to the distal femur metaphysis and placement of an MAAS (Figure 2B). An intramedullary nail with lateral locking plate was used for allograft fixation distally (Figure 2C).
case_images: PMC6540491_02
case_images: Radiographic images of patient 2 presenting radiographs (A), interval MAAS (B), and final reconstruction completed with a proximal femoral replacement (C). MAAS indicates modular articulating antibiotic spacer.
case_images: 10.1177_2151459319847399-fig3.jpg
case_images: PMC6540491_02_10.1177_2151459319847399-fig3.jpg
case_images: fig3-2151459319847399
case_images: Patient 2 is a 52-year-old female who presented with a current diagnosis of PJI with a history of pseudotumor resection after metal-on-metal total hip arthroplasty (Figure 3A). A MAAS (Figure 3B) was placed after aggressive resection of infected bone and soft tissue. She was reimplanted after 9.4 weeks using a proximal femoral replacement prosthesis (Figure 3C). She was allowed to weight bear as tolerated immediately after reimplantation postoperatively.
case_images: PMC6540491_03
case_images: Radiographic images of patient 3 presenting radiographs (A), interval MAAS (B), and final reconstruction done with a diaphyseal fitting modular tapered stem femoral component (C). MAAS indicates modular articulating antibiotic spacer.
case_images: 10.1177_2151459319847399-fig4.jpg
case_images: PMC6540491_03_10.1177_2151459319847399-fig4.jpg
case_images: fig4-2151459319847399
case_images: He presented to our clinic after removal of the previous prosthesis with a flail leg (Figure 4A). After resection, he was treated with an MAAS (Figure 4B) and was allowed to partial weight bear postoperatively. After allowing time to recover from 9 surgeries in 5 months, he was reimplanted after 35 weeks with a distal diaphyseal fitting modular tapered stem hip revision prosthesis (Figure 4C).
case_images: PMC6540491_04
case_images: Radiographic images of patient 4 presenting radiographs (A), interval MAAS (B), and final reconstruction with total femur placement and prophylactic proximal tibia plate (C). MAAS indicates modular articulating antibiotic spacer.
case_images: 10.1177_2151459319847399-fig5.jpg
case_images: PMC6540491_04_10.1177_2151459319847399-fig5.jpg
case_images: fig5-2151459319847399
case_images: She was initially treated with standard articulating hip and static knee antibiotic spacers (Figure 5A) along with IV antibiotics. We elected to treat her with an MAAS (Figure 5B) that extended to the tibia. After 6 weeks of IV vancomycin and by mouth ciprofloxacin, the patient was reimplanted with a total femur implant (Figure 5C) 20.5 weeks after placement of the MAAS.