Extensive Left Hip Debridement for Chronic Periprosthetic Joint Infection*

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Patient History

A 57-year-old woman with a complex surgical history involving multiple left hip revisions presented with acute pain, raising concern for a chronic periprosthetic joint infection (PJI). Her prior surgical history includes several left hip revisions, a two-stage exchange for E. coli and MRSA, and open reduction and internal fixation (ORIF) of a periprosthetic femoral fracture utilizing an allograft and cabling system.

Laboratory evaluation demonstrated elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Hip aspiration revealed an increased white blood cell (WBC) count with negative culture results.*

Treatment

Day 0, intraoperative findings revealed retained cables and strut allograft from a prior ORIF performed at another institution. The surgical team performed extensive irrigation and debridement, removed eight cables and the strut allograft, and exchanged the dual mobility head and liner while retaining the femoral implant. Restrata Sheet weas used to reinforce the compromised soft tissue closure, while Restrata MiniMatrix was applied within the tunneling aspects of the surgical wound.⁺ An incisional negative pressure wound therapy (NPWT) system was placed.

Closure Technique

• Placement of Restrata Sheet onto the debrided tissue bed for reinforcement of soft tissue
• Fascial closure over the Restrata Sheet
• Anchoring closure integrated with the Restrata material to support layered repair

Conclusion

At two weeks postoperatively, the patient demonstrated excellent short-term recovery with the following outcomes: complete wound healing, no pain (0/10), full muscular function, and independent ambulation without assistive devices. Despite challenges with patient non-compliance, the use of Restrata facilitated favorable short-term results and high patient satisfaction.

INTRAOPERATIVE

Retained cables and strut allograft from prior open reduction and fixation at another institution

INTRAOPERATIVE

Removed cables and strut allograft along with thorough irrigation and debridement, retained implant, placement of Minimatrix into tunneling aspects of the surgical wound

INTRAOPERATIVE

Placement of Restrata Sheet onto the base layer to provide reinforcement of the debrided tissue repair

INTRAOPERATIVE

Closure of fascial tissue over the Restrata Sheet

INTRAOPERATIVE

Anchoring closure to Restrata Sheet

WEEK 6 | POST OP

Please refer to product Instructions for Use for a full list of indications, contraindications, precautions, and warnings.

* Infection was controlled and no longer present at the time of Restrata application.
+Restrata MiniMatrix is indicated for wound management only and not soft tissue reinforcement.

MKG-30245-00

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