Antibiotic beads found with a skeletal example of complications from a hip replacement

Abstract

During maceration, a string of beads was found near the surgically modified right os coxa and femur of the remains of a 55-year-old woman donated to the Forensic Investigation Research Station at Colorado Mesa University. The remains were initially used in the study of decomposition of human remains, and then macerated to clean the skeleton. Documentation on this decedent noted three separate "hip replacement" surgeries, but no other details. The surgical modifications include significant alterations to the right os coxa and femur consistent with a Girdlestone procedure, generally used to treat an infected hip replacement unresponsive to other treatment. In this procedure, the surgeon removes the femoral head, and in this case, also the portion of the replacement in the os coxa. In this individual, a portion of the proximal femur was reflected, possibly to reduce contact with the os coxa. The beads are consistent with antibiotic beads, used to treat the infection that likely necessitated the Girdlestone procedure. Both the operation and the inclusion of the antibiotic beads are unusual and are potentially useful in the identification process.

Keywords: Girdlestone procedure; antibiotic beads; forensic anthropology; hip arthroplasty; osteology; scoliosis.