Two-stage revision of hip prosthesis infection using a hip spacer with stabilising proximal cementation

Abstract

Two-stage revision hip arthroplasty for infection using an antibiotic-loaded cement spacer has been used frequently with good results. However, spacer instability is also frequent. Proximal cementation of the spacer could avoid spacer dislocation. We retrospectively assessed 35 patients in whom a 2-stage revision hip arthroplasty for infection was carried out using an antibiotic-loaded cement spacer with gentamicin (Spacer-G) in which the spacer was proximally cemented in 16 patients. The mean follow-up was 32 months. We assessed spacer stability and infection elimination. There were 8 spacer dislocations (22.9%), 5 in hips without proximal cementation and 2 in hips with proximal cementation (p>0.05). There was no fracture in any hip. Reinfection occurred in 5 hips (14.3%), in 3 with the same microorganism, while 2 had a different microorganism. Our results indicate that the proximal cementation of the spacer prevents its dislocation. Infection was eliminated in 86% of the hips.

Spacers

“…We included 1,454 cases (Palacos, n = 1,201; and Simplex, n = 253). The infection control rate was similar in both groups with a rate of 93.7% (16 cases of reinfection) for Simplex and 93.8% (74 cases of reinfection) for Palacos cement …”

“…Most of the available studies are level 4 studies, followed by 5 level 3 studies and 4 level 2 studies. Only 1 level 1 study was available …”

“…The dose ranges reveal only the reported doses in the analyzed studies and are not recommendations . Again, the type of antibiotic and the dose needs to be individualized for each patient based on the organism profile and antibiogram (if available) as well as the patient's renal function and allergy profile.…”

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

“…In contrast to this, Gil Gonzalez reported a global rate of dislocation of 20%, in patients with proximal neck cementation the rate was 12.5%, in patients without proximal neck cementation the rate was 26.3%. 18 Due to HM spacers are moulded respecting patients' individual variables such as physiological neck varus/valgus and off-set it is possible to have a better articular congruence. As result this can explain the low dislocation rate observed in the HM group, in agreement with the results of Citak M et al 19 In the 2nd stage we implanted 15 long femoral stem prostheses in the Vancox group vs 6 in the HM group.…”

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

“…Other reasons include mismatching between spacer head and acetabular size (bigger or smaller head), abnormal spacer head-neck ratio and offset, severely damaged soft tissues (gluteus medius muscle), instable fixation of proximal spacer, and poor compliance postoperatively [ 24 – 26 ]. Reported incidence rate of spacer dislocation is up to 10-20% [ 25 – 27 ]. All patients in our current study had different degrees of acetabular bone defect and were treated with augmented antibiotic-loaded cement spacer.…”