Abstract
BackgroundSpacer 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.MethodsData 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.ResultsTwenty-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).ConclusionsAugmented 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.
Highlights
Periprosthetic joint infection (PJI) remains one of the most severe and devastating complications in total hip arthroplasty (THA)
Despite resurgent interest in one-stage revision [6], two-stage revision is presently considered as the “gold standard” for periprosthetic joint infection (PJI) treatment, reaching a rate of infection clearance ranging from 87 to 93% [7,8,9,10]
After the removal of acetabular and femoral prosthetic components and thorough extensive debridement performed in the first stage revision, surgeon would be in a dilemma, adopting resection arthroplasty, or, much better, implanting antibiotic-loaded spacer whether static [11] or articulating [12]
Summary
Periprosthetic joint infection (PJI) remains one of the most severe and devastating complications in total hip arthroplasty (THA). After the removal of acetabular and femoral prosthetic components and thorough extensive debridement performed in the first stage revision, surgeon would be in a dilemma, adopting resection arthroplasty, or, much better, implanting antibiotic-loaded spacer whether static [11] or articulating [12]. Articulating spacers have the advantages of maintaining joint mobility, reducing scar formation, preventing soft tissue contracture, and enabling the patients to bear weights after surgery. It has some potential disadvantages, like spacer dislocation, spacer fracture, peri-spacer fracture, and acetabular wear, especially for patients with acetabular bone defect, with reported complication rates between 13.2 and 58.8% [13, 14]. 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
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