Novel custom made composite spacer for first-stage revision total hip replacement in the presence of extensive acetabular/femoral bone loss with abductor deficiency

Abstract

A two-stage revision total hip replacement (THR) remains the gold standard for treating chronic periprosthetic joint infection. The goals for the first stage are twofold: (1) remove infected tissue/implants, obtaining tissue samples for culture; (2) deliver local antibiotics and maintain hip function with a prosthesis with antibiotic-loaded acrylic cement. With extensive bone loss prefabricated spacers are not sufficient, therefore customised spacers are required. The current technique, coating cephalomedually femoral nail in cement, is complex, time consuming, functions poorly and causes wear debris from excessive friction at the femoral/acetabular articulation. We report a technique to create a custom made composite spacer using a short femoral nail, standard Exeter femoral stem (Stryker), Trident acetabular cup (Stryker) and polymethyl methacrylate (PMMA) bone cement with antibiotics. This technique restores hip biomechanics and gives a stable articulation, even in the presence of abductor deficiency, due to dual mobility bearings.