Comparing the use of preformed vs hand-made antibiotic spacer cement in two stages revision of hip periprosthetic infection

Abstract

Background: The number of periprosthetic joint infections (PJI) is continuously increasing because of the increasing number of arthroprostheses performed every year. Two-stage revision, using antibioticloaded spacers, remains the gold standard for their treatment. The aim of our study is to compare the use of preformed vs hand-made spacers in hip arthroplasty infections evaluating infection eradication, bone loss and clinical/functional outcomes. Methods: From January 2010 to December 2017 we performed a prospective nonrandomized study. We pooled 50 patients affected by infected hip joint replacements, and divided them in 2 groups, one receiving commercially preformed spacers and the other receiving hand-made spacers. The study endpoint was set at 12 months. Intra-operative and peri-operative complications, Harris Hip Score (HHS), Short Form 12 Health Survey, intra-operative and radiological evaluation of bone loss were collected. Data were analyzed using descriptive statistics, T-test and Fisher Exact test. Results: We found a statistically significant differences (p < 0.05) between the two groups in favour of the VancogenX group for the following variables: surgical time, first and second stage intraoperative complication rates, infection eradication. Moreover, the preformed-spacers group had better results in the preservation of bone stock, even though the difference was not statistically significant (p > 0.05). Conclusion: Our results support the use of preformed antibiotic spacers, even though more studies are needed.

Custom-Made Antibiotic Cement-Coated Nail for the Treatment of Infected Bone Defect

“…Some authors think that the effect of a prefabricated good bone cement liner is better than that of handmade cushion [33]; We agree with this view, because preformed stents allow for better personalized treatment, better stent-wound match, better stability, more effective placeholders, and more effective sustained-release antibiotics. A prefabricated 3D printed intramedullary nail was also used to treat bone infection, but due to the complexity of trauma patients, the diversity of lesion sites, and the ease of implantation, the bone cement coating on the surface of the intramedullary nail was improvised intraoperatively.…”

The influence of different THA surgical approaches on Patient’s early postoperative anxiety and depression

“…In fact, the level of CRP and D-dimer were associated with the postoperative infection. However, according to our following observation, those patients collected in our studies have no severe complication [ 20 , 21 ]. CRP was considered to correlate with patient’s post-operative local tissue inflammation, which indicates that OCM most mildly affects patients’ inflammation reaction [ 22 , 23 ].…”

Two-stage strategy in end-stage hip periprosthetic joint infection: utility of industrially prefabricated custom-made antibiotic spacers

“…14 This premade option offers theoretical advantages: it has been proven mechanically safe; reliably efficient pharmacologically; and it saves precious operative time during the first-stage procedure. 17 Nevertheless, its use is still limited by cost, and even more so by unavailability of spacers sufficiently large to accommodate massive bone defects. A promising solution to these drawbacks is the option of requesting a factory-made custom antibiotic spacer.…”