Comparing Articulating Spacers for Periprosthetic Joint Infection After Primary Total Hip Arthroplasty: All-Cement Versus Real-Component Articulating Spacers.

Abstract

There are a variety of methods available to treat periprosthetic joint infection (PJI), including 2-stage revision with the use of an antibiotic spacer. This study compares the outcomes of real-component (RC) and all-cement (AC) articulating spacers for total hip arthroplasty (THA) PJI treatment. This multicenter retrospective study assessed all articulating spacers placed for THA PJI between April 2011 and August 2020. Patients were dichotomized based on spacer type (RC vs AC). One hundred four patients received articulating spacer constructs (RC group= 75, AC group= 29). Leg-length discrepancy was significantly greater in the AC group after the second stage (3.58 vs 12.00 mm, P= .023). There were no significant differences in reoperation rates following first-stage spacer placement (P= .752) and time to reimplantation (P= .127) between the groups. There were no significant differences in reinfection rates (RC group= 10.0%, AC group= 7.1%, P= 1.000) and reoperation rates following second-stage revision THA (RC group= 11.7%, AC group= 10.7%, P= 1.000). Hospital length of stay (in days) had a trend toward being shorter following the first (7.35 vs 11.96, P= .166) and second stage (3.95 vs 5.43, P= .107) for patients in the RC group. Patients in the RC group were more likely to be discharged home following the first (P= .020) and second (P= .039) stages. Given that there were no differences in reinfection and reoperation rates between the 2 spacer constructs, RC articulating spacers may provide a significant benefit for patient comfort during 2-stage exchange treatment of PJI while adding no increase in risk profile.