Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Abstract

Introduction Treating deep infection following THA has been a challenge. While the standard treatment has remained a two-stage revision, spacer designs, incorporated antibiotics, and concentrations have varied. Since control of infection may relate to choice and concentration of antibiotics, it is important to report rates of control from various spacers. Questions/purposes We therefore determined (1) the rate of infection control and (2) complications associated with a prefabricated, load-bearing, gentamicinimpregnated hip spacer in treating periprosthetic infections of the hip. Methods We retrospectively reviewed 33 patients with periprosthetic THA infections treated with a prefabricated, partial load-bearing, gentamicin-impregnated hemiarthroplasty spacer. Thirty of the 33 patients underwent second stage reimplantation after a mean 15 weeks. We collected patient demographic data, laboratory values, infecting organism, size of spacer mold, antibiotic selection, complications, and infection control rates from two academic centers. Recurrent infection at last followup was determined by the presence of physical symptoms or signs or elevated serologic tests. The minimum followup was 24 months (mean, 43 months; range, 24-70 months).

Industrially Prefabricated Cement Spacers: Do Vancomycin- and Gentamicin-impregnated Spacers Offer Any Advantage?

“…The overall control rate (83%) is comparable to rates reported in other studies [11,25,27,38]. An ongoing criticism of the industrially premade spacer concerns the limited selection of antibiotics offered and the use of dosages less than those recommended for treatment of infections [16,38].…”

“…These prefabricated spacers have proven to be mechanically safe [11,25,27], with a low number of complications.…”

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

“…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.…”