Commercially manufactured spacers for the treatment of periprosthetic joint infection of the hip.

Abstract

Periprosthetic joint infection remains acommon and serious complication after hip arthroplasty. To improve function and patient comfort after joint removal in two-stage revision, commercially manufactured spacers for the hip joint allow retention of the anatomical joint geometry thereby limiting soft tissue contraction and allow mobilization. Periprosthetic joint infection of the hip, septic arthritis with severe destruction of the hip cartilage and/or bone requiring arthroplasty. Allergies to polymethylmethacrylate (PMMA) or antibiotics, severe hip dysplasia with insufficient cranial support, incompliant patient, large osseous defect of the acetabulum, insufficient metaphyseal/diaphyseal support of the femoral bone, resistance of the microbiological pathogen to spacer-inert antibiotic medication, inability to perform primary wound closure requiring temporary open-wound therapy. Preoperative templating on radiograph; removal of joint prosthesis and thorough debridement with removal of all foreign material; trial spacer selection and insertion and trial reduction of the joint, fixing the spacer with PMMA to the proximal femur, final reduction, radiograph and stability test. Data were analyzed from patients treated between 2016 and 2021. In all, 20patients were treated with preformed spacers and 16with custom-made spacers. Pathogens were detected in 23of the 36cases (64%). Polymicrobial infections were present in 8of 36cases (22%). In patients who received preformed spacers, there were 6cases of spacer-related complications (30%). Of the 36patients (83%), 30were reimplanted with anew implant; 3patients died due to septic or other complications before reimplantation (8%). Average follow-up was 20.2months after reimplantation. There were no major differences between the two groups of spacers. Patient comfort was not measured.