Preliminary results of a novel spacer technique in the management of septic revision hip arthroplasty.

Abstract

Mechanical failure due to dislocation, fracture and acetabular wear is a major complication associated with the use of spacers in the management of periprosthetic joint infection (PJI). We have developed a novel custom-made spacer in the setting of two-stage septic revision hip arthroplasty and present the preliminary results of our technique. Between May 2015 and November 2017, 30 patients underwent hip revision using the ENDO spacer technique in the setting of a two-stage septic exchange arthroplasty. The technique involves the dual mobility liner and the downsized stainless cemented straight stem in combination with antibiotic-loaded PMMA bone cement. The primary outcome measure was the overall spacer complication rate, particularly spacer dislocation. Furthermore, functional outcome using the Harris Hip Score (HHS) before spacer implantation and prior re-implantation was evaluated. The mean age of the patients was 69.8years (range from 45 to 85; SD = 9.9years). No microorganisms were preoperatively found in 23 (76.7%) cases. Successful re-implantation was performed in all patients after a mean spacer duration time of 53.6days (range 14-288days; SD = 48.2). Spacer-related complications occurred in only two patients (6.7%). The HHS significantly improved from 34.0 (range 3-62; SD = 15.1) to 48.1 (range 11-73; SD = 15.7) (p = 0.0008). The ENDO spacer surgical technique is a feasible option in the treatment of periprosthetic joint infection (PJI), with a low dislocation rate. Furthermore, it allows early mobilization with the possibility of full-weight bearing.