Spacer endoprosthesis for the treatment of infected total hip arthroplasty

Durbhakula, Sridhar M.; Czajka, John; Fuchs, Marc D.; Uhl, Richard L.

doi:10.1016/j.arth.2004.02.037

Cited by 116 publications

(81 citation statements)

References 15 publications

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“…These temporary spacers are usually expected to be removed and replaced by new implants at the time of second stage reimplantation. In practice, however, the second stage reimplantation is not always performed as scheduled for various reasons and temporary spacers are occasionally retained as a permanent solution for infection control [4,5].In the literature, prolonged spacer implantation has been sporadically described [4][5][6][7]. However, detailed information of follow-up outcome of retained spacers has not been well documented.…”

mentioning

confidence: 97%

The Fate of Unplanned Retention of Prosthetic Articulating Spacers for Infected Total Hip and Total Knee Arthroplasty

Choi

Freiberg

Malchau

et al. 2014

The Journal of Arthroplasty

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mentioning

confidence: 97%

The Fate of Unplanned Retention of Prosthetic Articulating Spacers for Infected Total Hip and Total Knee Arthroplasty

Choi

Freiberg

Malchau

et al. 2014

The Journal of Arthroplasty

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“…The application of articulating polymethylmethacrylate (PMMA) spacers to manage the patients between stages has recently become a common approach. 6,7 When impregnated with antibiotics, these spacers not only serve as a temporary hip prosthesis to retain soft tissue tension, maintain joint function, and facilitate subsequent reimplantation, 8,9 but can also be utilized as a potential local drug delivery system to provide high antibiotic levels at the infection site. 10 The use of antibiotic-impregnated PMMA bone cement to treat musculoskeletal infections has been reported in literature for decades.…”

Section: Introductionmentioning

confidence: 99%

High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex™ cement spacers in two‐stage revision of infected hip implants: A study of 46 patients at an average follow‐up of 107 days

Hsieh

Chang

Chen

et al. 2006

Journal Orthopaedic Research

116

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This study investigated the release of antibiotics in vivo, from an articulating polymethylmethacrylate (PMMA) spacer used in two-stage revision arthroplasty of infected hip implants. Forty-six patients who underwent two-stage revision hip arthroplasty for infections were managed with an interim PMMA spacer loaded with a high dose of vancomycin and aztreonam. Serum and aliquots of drainage collected after the first-stage surgery, and joint fluid obtained at the time of the second-stage surgery were analyzed for antibiotic concentrations by high performance liquid chromatography and bioactivity by tube dilution bioassay. Following implantation, the highest levels of antibiotics were measured in aliquots of drainage on the first day (vancomycin: 1538.0 AE 243.6 mg/mL; aztreonam: 1003.5 AE 323.5 mg/mL), decreasing to 571.9 AE 169.4 mg/mL for vancomycin and 313.6 AE 88.3 mg/mL for aztreonam after 7 days. Antibiotic concentrations in serum were very low (vancomycin: 0.58 AE 0.2 mg/mL, range: 0.1-1.6 mg/mL; aztreonam: 0.46 AE 0.3 mg/mL, range: 0.1-0.9 mg/mL at 24 h) and there was no systemic adverse effect. At a mean 107 days after the first-stage surgery, the concentrations of antibiotics in joint fluid were well above the minimal inhibitory concentration of most common microorganisms. The released antibiotics were bioactive against the test organisms. Based on the observed results, we confirmed the safety and effectiveness of in vivo drug delivery from antibiotic-impregnated PMMA hip spacers. ß

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“…Leunig et al [11] reported mechanical complications in 50% of cases in a series of 12 patients treated with hand-made spacers, while Durbhakula et al [6] reported mechanical complications in 20% of patients treated with an intraoperative mold-made spacer.…”

Section: Discussionmentioning

confidence: 98%

“…In literature, several spacers are reported, hand-made or molded during the surgery with definite success rate in terms of infection eradication, but with high incidence of mechanical complications ranging from 10 to 25% [6,7] and unpredictable antibiotic release.…”

Section: Introductionmentioning

confidence: 98%

The use of a preformed spacer in two-stage revision of infected hip arthroplasties

et al. 2011

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Two-stage revision with the use of an antibiotic-loaded cement spacer has spread widely as a successful treatment for THA infection. Between 1999 and 2008, 28 patients with infected THA were treated with two-stage implant revision using a preformed spacer. The spacer was left in situ for 5.5 months (range 1-13 months), and the patients were allowed to walk with partial weight bearing. At a mean follow-up of 53 months (range 18-106 months), recurrence of infection was observed in only one patient. Complications were observed in five patients: three spacer dislocations, one distal femoral fracture occurred during stem removal, and one femoral artery pseudo-aneurysm. The mean HHS increased from 43 points (range 13-77) to 82 points (range 35-96). Though small prospective studies are reported in literature, good eradication rate and good functional outcomes encourage for the use of an antibiotic-loaded cement spacer. The industrial production ensures procedure standardization, well-defined physical and chemical properties to the device and eliminates time necessary to intraoperatory manufacturing.

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Spacer endoprosthesis for the treatment of infected total hip arthroplasty

Cited by 116 publications

References 15 publications

The Fate of Unplanned Retention of Prosthetic Articulating Spacers for Infected Total Hip and Total Knee Arthroplasty

The Fate of Unplanned Retention of Prosthetic Articulating Spacers for Infected Total Hip and Total Knee Arthroplasty

High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex™ cement spacers in two‐stage revision of infected hip implants: A study of 46 patients at an average follow‐up of 107 days

The use of a preformed spacer in two-stage revision of infected hip arthroplasties

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