A cement spacer for two-stage revision of infected implants of the hip joint

Abstract

We report the technical details and clinical results of twelve patients who had deep infections of implants in the hip joint and were treated by two-stage revision, using a gentamicin-loaded, hand-moulded cement spacer inserted for the period between resection and reimplantation arthroplasty. During management with the spacer, usually for 4 months, patients were almost free of pain and mobile with good leg control, spending 2/3 of the treatment period at home. Six of twelve spacers failed locally due to dislocation [5] or cement fracture [1], and more than two further episodes of surgery were required in 3 patients. Problems with dislocation of the spacer were significantly higher when the head to neck offset was lacking (P< 0.05) or when anchorage in the femoral shaft was poor. Nevertheless, infection after reimplantation arthroplasty did not occur by the time of follow-up (2.2 years). Based on these data, we consider that the use of the cement spacer is a promising approach to the treatment of complicated infections of the hip joint.

Preformed acrylic bone cement spacer loaded with antibiotics: Use of two-stage procedure in 10 patients because of infected hips after total replacement

“…One of our spacers dislocated early because it had too small a head, as also reported by Leunig et al (1998). This shows the need for models of various sizes.…”

“…Today, the two-stage revision procedure, initially limited to removal of the infected prosthesis with local administration of antibiotics using continuous irrigation, is usually done with tempor ary variously-shaped spacers of bone cement and antibiotics prepared in the operating room (Zilkens et al 1990, Abendschein 1992, Duncan and Beauchamp 1993, Leunig et al 1998, Younger et al 1998.…”

Infection in total hip replacement: meta-analysis

“…Rates of eradication have been reported from 84 to 100% using this method [8,12,18,25,26,45]. Adequate bone stock is required to ensure durability of this approach.…”

Pros and Cons of Spacers in the Treatment of Late Periprosthetic Infections of the Hip

“…Leg shortening and instability still occur and cause problems with mobilization. Re-implantation of prosthesis is also often made more difficult because of scarring, tissue shrinkage and osteoporosis caused by inactivity [14][15][16]. In addition, abrasion of zirconium dioxide particles is to be expected during mobilization and this could lead to third-body-wear following re-implantation of the prosthesis.…”

“…The potential disadvantages of the monoblock spacers are spacer fracture and bone resorption [15,30]. The monoblock spacer induces bone resorption at the acetabulum because the hard cement has to articulate against the osteoporotic bone caused by the infection.…”