A preformed temporary antibiotic-loaded cement spacer for the treatment of destructive septic hip arthritis: a case report

Abstract

Preformed spacers have proved to be effective in the two-stage revision of infected total hip replacements. In the treatment of septic arthritis of the hip, the use of a temporary device has occasionally been described, but the implantation of a preformed antibiotic-loaded spacer has not yet been reported. A 71-year-old man with a destructive Staphylococcus aureus septic arthritis of the hip joint was admitted to hospital. Given the persistence of local infection regardless of all antibiotics and the worsening of joint damage, an aggressive surgical treatment including early placement of a preformed temporary spacer loaded with antibiotics was performed. Two months later an uncemented total hip replacement was successfully implanted. Two years after surgery the patient had a complete functional recovery with no signs of recurrence. The advantages of a preformed device include an effective and predictable local release of antibiotics and a mechanically tested resistance that allows early partial weight bearing and immediate joint mobilization.

An Articulating Antibiotic Spacer Controls Infection and Improves Pain and Function in a Degenerative Septic Hip

“…Because the use of an interim antibioticloaded cement spacer with resection of all infected components has been a well-established treatment for an infected THA [8,9,12,15] with low periprosthetic infection rates, we questioned whether the treatment of a degenerative hip with active or recent septic arthritis could also be treated with the use of an antibiotic spacer followed by conversion to a THA. Furthermore, there have been two case reports [1,17] and one case series with a subset of six patients [23] in the literature using two-stage exchange for the treatment of a native septic hip with no evidence of recurring periprosthetic infection. Our findings echo those in the literature (Table 2).…”

“…Of the 10 patients who underwent conversion to THA, seven patients were then seen in the clinic at 1 year or more with radiographic imaging. Seven patients were also contacted by telephone (including the three patients not seen in clinic at 1 year) at a mean of 56 months from the insertion of the THA and the overall outcome of the procedures and their effect on their pain and functional improvement after each surgery were assessed through the use of a modified Harris hip score (which assesses pain and function but does not allow for evaluation of ROM or deformity) [17,20]. Two of the three patients who could not be contacted for the telephone survey had presented from outside the country seeking specialized care and did not respond to attempted contact.…”

“…Its use in patients with advanced DJD with a coexisting or recent septic arthritis has been reported in a subset of six patients from a larger case series [23] and two case reports [1,17]. Infection was controlled in all of these patients but the small number of patients precludes any definitive judgment of the technique.…”

Spacers

“…Most of the available studies are level 4 studies, followed by 5 level 3 studies and 4 level 2 studies. Only 1 level 1 study was available …”

“…The dose ranges reveal only the reported doses in the analyzed studies and are not recommendations . Again, the type of antibiotic and the dose needs to be individualized for each patient based on the organism profile and antibiogram (if available) as well as the patient's renal function and allergy profile.…”