Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

Abstract

BackgroundOutcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol.MethodsNineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS]) and hip joint function (Harris Hip score).ResultsThe mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104) months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84) pre-operatively to 18 (range, 0 - 38) prior to spacer removal and to 8 (range, 0 - 15) at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment.ConclusionsSatisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.

Are Preformed Articulating Spacers Superior To Surgeon-made Articulating Spacers in the Treatment Of PJI in THA? A Literature Review

“…Since then, several authors reported on the outcomes using those preformed hip spacers (Spacer-G and InterSpace ® Hip) in the interim period of two-stage revision arthroplasty [3][4][5][6][7][8][9][10][11][12]. Most of the studies are limited due to a small number of included cases or due to a relatively short follow-up time.…”

“…The inner part of the spacer usually contains a stainless steel rod, which is covered by antibiotic loaded cement. The cement is preloaded by the manufacturer most often with 1.9 g gentamicin sulfate [3][4][5][6][7][8][9][10][11][12]. Surgeon-made spacers are intraoperatively preformed spacers ranging from hand-made techniques using a bulb syringe to fashion a femoral head, to molded systems with or wihtout a metal endo-skeleton, while in the majority of cases, metal endoskeleton was not used.…”

“…The level of evidence (level I-IV) was noted in every study according to the criteria set forth by the Oxford 2011 guidelines for level of evidence [13]. According to these guidelines, there were 3 level II, 4 level III and 36 Level IV studies (Tables 1a and 1b) [2][3][4][5][6][7][8][9][10][11][12].…”

“…The authors concluded, that preformed spacers were superior to custom-made spacer regarding functional outcome and complication rate, while the eradication rate was similar between both groups [2]. Since then, several authors have reported on the outcomes of preformed hip spacers (Spacer-G and InterSpace ® Hip) in the interim period of two-stage revision arthroplasty [3][4][5][6][7][8][9][10][11][12]. Many of these studies are small case series and it remains unclear if preformed hip spacers are superior to surgeon-made hip spacers in the treatment of periprosthetic joint infection following primary THA.…”

Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange

“…In recent decades, the risk decreased by the use of laminar airflow, antibiotic prophylaxis, antibiotic loaded bone cement (PMMA), rigorous hygiene standards, and standardized surgical procedures [3,[5][6][7]. Despite these efforts, infection after implantation of total hip arthroplasty (THA) is still a serious problem for patients, physicians and the general public [2].…”