Treatment Of Infected Total Hip Arthroplasty Research Articles

The Use of a Supra-Acetabular Antibiotic-Loaded Cement Shelf to Improve Hip Stability in First-Stage Infected Total Hip Arthroplasty

BackgroundAntibiotic-loaded cement spacers in first-stage revision total hip arthroplasty (THA) for managing infection are associated with high dislocation and fracture rates. The aim of this study was to report the use of an antibiotic-loaded cemented supra-acetabular roof augmentation to reinforce hip stability after cement spacer insertion for first-stage total hip revision in the treatment of infected THA. MethodsWe retrospectively reviewed a consecutive series of 50 THAs involving 47 patients with an infected hip requiring staged revisions of THA. We documented dislocation, reinfection, and time for revision and outcome. ResultsThere were no cases of hip dislocation, cement fractures, or any other technical complications associated with the use of the roof augmentation lip. Thirteen cases (26%) had a cemented spacer for longer than 120 days. Seven (14%) cases had recurrent infection after staged revision THA. ConclusionThe antibiotic-loaded cemented supra-acetabular roof augment improved femoral head spacer coverage for patients requiring a staged revision THA for infection.

Cement-within-cement revision of infected total hip replacement; disappointing results in 10 retrospective cases.

This retrospective analysis evaluates 10 patients with a late infection of a cemented total hip arthroplasty (THA) treated with two-stage revision with retention of the original well-fixed femoral cement mantle. Clinical, laboratory, and radiological outcomes were evaluated. The average age at the first-stage revision procedure was 61.5 years (range 38-80 y). The mean follow-up period was 26 months (range 5-54 m). Successful eradication of the primary microorganism was achieved in 2 patients. These patients had negative cultures at second stage and did not show any signs of infection during follow-up.The other 8 patients were considered as failures. In 3 patients, the femoral cement mantle was removed after the first stage due to recurrent infection in Girdlestone situation. In 2 patients, cultures showed the same micro-organism at first and second stage, treated with 3 months of antibiotics after second stage. 2 patients showed negative cultures at second stage but still had recurrent infection afterwards. These where treated with debridement and implant retention (DAIR) and 3 months of antibiotics. 1 patient was treated with suppressive antibiotics for persistent prosthetic joint infection after second stage, despite DAIR and therapeutic antibiotic treatment. Based on this study, results of two-stage revision with retention of femoral cement mantle are disappointing in treatment of infected THA. Therefore, more research is required to determine which patients are appropriate for cement-within-cement revision.

Are Preformed Articulating Spacers Superior To Surgeon-Made Articulating Spacers in the Treatment Of PJI in THA? A Literature Review.

Background and Purpose:Antibiotic-loaded cement spacers are typically manufactured by surgeons in the operating room. However, if the infecting organism is known preoperatively, the cement spacer can be fabricated (Spacer-G® or the InterSpace® Hip) in advance. It is unclear if preformed hip spacers are superior to surgeon-made hip spacers in the treatment of periprosthetic joint infection following primary THA.Methods:A literature review of the peer-reviewed literature indexed by MEDLINE and Embase was performed to identify studies reporting the outcomes of preformed and surgeon-made hip spacers in the treatment of infection following primary total hip arthroplasty (THA). A total of 43 articles met the inclusion criteria and were included in the analysis to compare the reinfection rate, Harris Hip Score (HHS) and spacer complication rates between surgeon-made and preformed hip spacers.Results and Interpretation:The analyzed studies included a total number of 1631 infected THA cases (n=1027 surgeonmade; n=604 preformed spacers). We found similar reinfection rates (6.0% surgeon-made, and 5.5% preformed spacers) and similar mean HHS at latest follow-up after reimplantation (HHS=84.3 surgeon-made, and HHS=81.8 preformed spacers) between both groups. However, patients treated with a surgeon-made articulating spacer had a higher spacer fracture rate compared to preformed articulating spacer. The use of preformed articulating spacers in the treatment of infected THA is not superior to surgeon-made articulating spacers regarding infection control and functional outcomes. However, the use of surgeon-made antibiotic spacers increased the risk of spacer fracture.