Use of an antibiotic impregnated polymethyl methacrylate intramedullary spacer for complicated revision total hip arthroplasty

Abstract

Revision total hip arthroplasty is frequently necessary in the presence of significant proximal femoral bone loss, periprosthetic fracture, or infection. In these situations, optimal reconstruction may sometimes warrant the use of special implants, including bone grafts. The emergent presentation of these cases or unexpected findings at the time of surgery can preclude the use of these treatment options. In cases of periprosthetic sepsis, delayed reimplantation may be the most successful approach to eradicate infection. In seven of these complicated revision total hip arthroplasties, the authors used an antibiotic-impregnated intramedullary polymethyl methacrylate spacer with delayed prosthetic reimplantation to allow for the use of these methods. Benefits of this technique include uncompromised radiographic evaluation of the proximal femur for design of a custom implant, if needed, stabilization of the proximal femur facilitating early mobilization of the patient in the case of periprosthetic fracture, and local delivery of antibiotics to the wound in the case of infection. The author's ability to reconstruct these total hip arthroplasties complicated by bone deficiency, fracture, and sepsis, was significantly improved with this use of this technique.