A new biarticular cement spacer technique for infected total hip and knee arthroplasty with massive bone loss

Abstract

Introduction: The management of massive femoral bone defects following prosthetic infection remains a surgical challenge, particularly when the entire femur is affected. Methods: We present the first results of a new biarticular cement spacer with antibiotic technique using a cephalomedullary nail for the treatment of infected hip arthroplasty involving complete femoral bone loss. Results: 5 patients with a minimum follow-up of 1 year were included. In all cases 2-stage replacement due to hip periprosthetic infection was carried out, with the need for a biarticular complete femoral spacer in view of the magnitude of the bone defect. The infection was resolved in all patients, with no complications (spacer fracture or dislocation) associated to spacer use, and the patients were all able to maintain the sitting position with active knee movements between the 2 surgical stages. Improvement with respect to preoperative functional status was observed in all cases, as evidenced by the Harris Hip Score (HHS) (from 24.2 to 73; p < 0.001) and 12-Item Short-Form Health Survey (SF-12) (from 16.8 to 33.2; p = 0.001), with a lessened need for walking aids. Discussion: The described technique offers a possible solution to a number of complications observed with the use of spacers in massive defects, affording greater patient comfort and autonomy while waiting to receive total femoral replacement.

Determination of the Elution Capacity of Dalbavancin in Bone Cements: New Alternative for the Treatment of Biofilm-Related Peri-Prosthetic Joint Infections Based on an In Vitro Study

“…However, some of the antibiotics conventionally used have unfavorable characteristics for local use in PMMA (low release, short half-life, etc.) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Even so, given the absence of more effective alternatives, their use remains the gold standard for the treatment of bone infections.…”

Treatment of periprosthetic knee infection and coexistent periprosthetic fracture: A case report and literature review

“…In the revision surgery, the tibial fracture site was stabilized with a long uncemented stem. Sanz-Ruiz et al [ 27 ] presented a biarticular cement spacer, made from a cephalomedullary nail, to treat infected hip arthroplasty with massive bone loss. They covered the nail with antibiotic-laden cement and obtained satisfactory results of infection control and functional retention.…”

Utilizing a Prefabricated Antibiotic-Impregnated Articular Spacer Combined With an Intramedullary Device for Significant Femoral Bone Loss in Periprosthetic Hip Infection

“…Sanz-Ruiz et al. provided another outlook of a technique with similar principles as ours using a biarticular cement spacer for infected total hip and knee arthroplasty which had massive bone loss [ 17 ]. Focusing on the hip, their technique used the same principles as mentioned above to create a femoral head using a bulb syringe [ 17 ].…”

“…provided another outlook of a technique with similar principles as ours using a biarticular cement spacer for infected total hip and knee arthroplasty which had massive bone loss [ 17 ]. Focusing on the hip, their technique used the same principles as mentioned above to create a femoral head using a bulb syringe [ 17 ]. They did, however, note that it worked better to invert the bulb prior to cement casting to avoid creating an uneven surface with crests as seen in the study by Sancineto et al.…”