Individual bone cement spacers (IBCS) for septic hip revision—preliminary report

129

The aim of this retrospective study was to identify and evaluate complications after hip spacer implantation other than reinfection and/or infection persistence.Between 1999 and 2008, 88 hip spacer implantations in 82 patients have been performed. There were 43 male and 39 female patients at a mean age of 70 [43 - 89] years. The mean spacer implantation time was 90 [14-1460] days. The mean follow-up was 54 [7-96] months. The most common identified organisms were S. aureus and S. epidermidis. In most cases, the spacers were impregnated with 1 g gentamicin and 4 g vancomycin / 80 g bone cement.The overall complication rate was 58.5 % (48/82 cases). A spacer dislocation occurred in 15 cases (17 %). Spacer fractures could be noticed in 9 cases (10.2 %). Femoral fractures occurred in 12 cases (13.6 %). After prosthesis reimplantation, 16 patients suffered from a prosthesis dislocation (23 %). 2 patients (2.4 %) showed allergic reactions against the intravenous antibiotic therapy. An acute renal failure occurred in 5 cases (6 %). No cases of hepatic failure or ototoxicity could be observed in our collective. General complications (consisting mostly of draining sinus, pneumonia, cardiopulmonary decompensation, lower urinary tract infections) occurred in 38 patients (46.3 %).Despite the retrospective study design and the limited possibility of interpreting these findings and their causes, this rate indicates that patients suffering from late hip joint infections and being treated with a two-stage protocol are prone to having complications. Orthopaedic surgeons should be aware of these complications and their treatment options and focus on the early diagnosis for prevention of further complications. Between stages, an interdisciplinary cooperation with other facilities (internal medicine, microbiologists) should be aimed for patients with several comorbidities for optimizing their general medical condition.

Section: Discussionmentioning

confidence: 99%

Complications after spacer implantation in the treatment of hip joint infections

Jung¹,

Schmid²,

Kelm³

et al. 2009

129

“…The lacking leg length discrepany allows an almost physiological joint mobility which could serve in the prophylaxis of pneumonia and thrombosis 22. Furthermore, some authors permit a partial weight bearing with the spacer 5, 19, 24, which can be performed painfree in most cases, in contrast to the excision arthroplasty 16. A disuse osteoporosis and muscle atrophy are hereby prevented so that the later prosthesis reimplantation is facilitated 29.…”

Section: Discussionmentioning

confidence: 99%

“…A probable cause might be the reduced weight bearing properties of our spacer. Therefore, the enhancement of the spacer's stability should be the aim of further investigations, either with the insertion of a metallic endoskeleton or with K-wires 7-8, 14, 19.…”

Section: Discussionmentioning

confidence: 99%

Treatment of proximal femur infections with antibiotic-loaded cement spacers

Kelm¹,

Bohrer²,

Schmitt³

et al. 2009

In case of periprosthetic hip infections the implantation of antibiotic-loaded PMMA spacers is accepted for an adequate treatment option. Although their indication for the treatment of destructive, bacterial infections of the proximal femur would make sense, literature data are scarce. Hence, the aim of this study was to evaluate the efficacy of antibiotic-impregnated spacers in the treatment of proximal femur infections.In 10 consecutive patients (5 M/ 5 F, mean age 66 y.) with bacterial proximal femur infections, a femoral head/neck resection was prospectively performed with a subsequent implantation of an antibiotic-loaded spacer. The joint-specific outcome was evaluated by the Merle d´Aubigne and the Mayo hip score, the general outcome by SF-36. The time periods were divided into “infection situation”, “between stages” and meanly 1 year “after prosthesis implantation”.The spacers were meanly implanted over 90 [155-744] days. In all cases an infection eradication could be achieved. After infection eradication, a prosthesis implantation was performed in 8 cases. The general scores showed significant increases at each time period. With regard to the dimension “pain”, both scores demonstrated a significant increase between “infection situation” and “between stages”, but no significance between “between stages” and “after prosthesis implantation”.Spacers could be indicated in the treatment of proximal femur infections. Besides an infection eradication, a pain reduction is also possible.

“…Schöllner et al investigated in vitro the mechanical properties of gentamicin-loaded hip spacers after insertion of Kirschner wires 7. Stress experiments showed an average failure load of 1.6 kN.…”

Section: Mechanical Complications and Reconstruction Strategiesmentioning

confidence: 99%

Mechanical complications and reconstruction strategies at the site of hip spacer implantation

Anagnostakos¹,

Jung²,

Schmid³

et al. 2009

Over the past two decades antibiotic-impregnated hip spacers have become a popular procedure in the treatment of hip joint infections. Besides infection persistence and/or reinfection, major complications after hip spacer implantation include spacer fracture, -dislocation, and bone fracture. Moreover, in cases with extensive loss of femoral and/or acetabular bone alternative reconstructive techniques should be used for a stable spacer fixation and prevention of fractures or dislocations. The present article reviews the different types of spacer fractures and dislocations and offers some suggestions about reconstructive techniques for management of extensive loss of femoral and/or acetabular bone at the site of hip spacer implantation.