The use of augmented antibiotic-loaded cement spacer in periprosthetic joint infection patients with acetabular bone defect

Abstract

Background Spacer complications may affect final clinical outcome of the two-stage approach in periprosthetic joint infection (PJI) patients. This study aimed to investigate clinical outcomes and complications of augmented antibiotic-loaded cement spacer in PJI patients with acetabular bone defect. Methods Data on PJI patients with acetabular bone defect receiving two-stage revision from January 2009 to December 2016, in our hospital were retrospectively reviewed. Screw-cement-shell was used to improve the stability of the hip with acetabular wall defect. Handmade acetabular spacer could prevent femoral spacer entering into pelvis in patients with acetabular internal wall defect. A total of 26 patients (11 males and 15 females) were included in the current study. Their mean age was 46.7 ± 15.4 years old. Clinical outcomes and complications were measured. Results Twenty-one of total 26 hips (21/26, 80.8%) showed positive cultures and 15/26 (57.7%) samples were cultured with staphylococcus. Of enrolled patients, 5/26 (19.2%) developed mixed infection. There was one patient (3.8%) with spacer dislocation and two (7.7%) with spacer fracture. One patient developed acute PJI 5 years after the second-stage revision, so overall success rate among these patients was 96.2%. Differences in Paprosky classifications before the first and second stage did not reach significant level (p > 0.05). Hip Harris score was raised from 40.9 ± 14.0 to 81.2 ± 11.2 (p < 0.05). Conclusions Augmented antibiotic-loaded cement spacer could achieve satisfactory clinical outcomes in PJI patients with acetabular bone defect. It provided joint mobility, increased additional joint stability, and decreased iatrogenic bone defect caused by acetabular wear.

Fracture-Related Infection in Bicolumnar Acetabular Fracture: A Case Report

“…In the two-stage revision, a hip spacer can be a solution. Its major complication is dislocation due to its intrinsic instability; in our case reports, there was a persistent fracture of the acetabulum, which did not allow the implanting of a hip spacer without significant risk [ 30 , 31 ]. Thus, we treated the fracture-related infection with a two-stage revision, while septic arthritis of the hip with a one-stage revision [ 14 , 32 ].…”

Systematic Review on the Current Situation and Development of Local Antimicrobial Agents in Revision Arthroplasty for Periprosthetic Joint Infection (PJI)

“…The ability of antibiotic-loaded cement spacers being feasible lies in their ability to deliver high concentrations of antibiotics to the target site (Fu et al, 2020). The local delivery reduces the systemic side effects that are related with prolonged oral or intravenous antibiotic therapy.…”

“…Medical personnel most of the time consider the approach during a staged approach; There are two stages involved , the first stage which involves the removal of the infected prosthesis implanting antibiotic-loaded spacer and also administering systemic antibiotics. In the second stage the spacer is later removed, and finally a new prosthesis is implanted (Fu et al, 2020).…”