Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2025; 92(5):293-297 | DOI: 10.55095/achot2025/026

Revision Arthroplasty for Periprosthetic Femoral Fracture Complicated by Multidrug-Resistant Escherichia coli: Case Report and Minireview

JAROSLAV KRAUS¹, VLASTA KRAUSOVÁ², HYNEK BARTOŠ³, TOMÁŠ NOVOTNݹ

¹ Ortopedická klinika Fakulty zdravotnických studií Univerzity J. E. Purkyně v Ústí nad Labem a Krajské zdravotní a. s. - Masarykovy nemocnice v Ústí nad Labem, o. z.

² Dětská klinika Fakulty zdravotnických studií Univerzity J. E. Purkyně v Ústí nad Labem a Krajské zdravotní a. s. - Masarykovy nemocnice v Ústí nad Labem, o. z.

³ Infekční klinika 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Bu lovka, Praha

Periprosthetic infections caused by multi-resistant bacteria are one of the most fearsome complications in current orthopedics. Despite using aseptic modern practices, the number of infectious complications caused by multidrug-resistant strains is rising worldwide. We present a case of a woman with a non-healing wound after hip arthroplasty revision surgery performed in Egypt for periprosthetic femoral fracture. Upon admission, 11 days after surgery, she presented with a purulent secretion from surgical wound and signs of sepsis. Carbapenem-resistant E. coli was proven from a wound swab. Two-stage revision with a 6-week-long interval of targeted parenteral antibiotic therapy was indicated. During explantation, excessive femoral bone loss after inadequately performed trauma revision surgery was discovered. After antibiotic hip spacer period, the patient underwent implantation of a cemented tumorous revision hip implant followed by 6 weeks of antibiotic therapy. The patient was discharged in more than satisfactory condition, being self-sufficient using French crutches. In follow-up visits during next 2 years, no relapse of carbapenem-resistant infection occurred. In patients hospitalized or operated in high-risk areas, epidemiological anamnesis is of great importance and the possibility of importing multi-resistant bacteria should be considered. Infections caused by these bacteria prolong therapy and increase the cost of treatment significantly. The combination of arthroplasty extraction and targeted antibiotic therapy is recommended to treat periprosthetic infections.

Keywords: hip arthroplasty, arthroplasty revision, periprosthetic fracture, periprosthetic infection, multidrug-resistant E. coli.

Received: March 30, 2025; Revised: March 30, 2025; Accepted: June 14, 2025; Published: December 1, 2025  Show citation