Hip Pelvis.  2020 Mar;32(1):26-34. 10.5371/hp.2020.32.1.26.

Staged Revision of Infected-hip Arthroplasty Using an Antibiotics-loaded Intra-articular Cement Spacer: Impact on Cemented and Cementless Stem Retention

• Um KS
• Lee JW
• Yoon BH
• Sung YB

• KMID: 2471128
• DOI: http://doi.org/10.5371/hp.2020.32.1.26

Abstract

PURPOSE
Currently, standard management of a peri-prosthetic infection is a two-stage revision precedure. However, removal of well-fixed cement is technically demanding and associated with numerous potential complications. For theses reasons, two-stage revision with preservation of the original femoral stem can be considered and several previous studies have achieved successful results. While most prior studies used cemented stems, the use of cementless stems during arthroplasty has been gradually increasing; this study aims to assess the comparative effectiveness of a two-stage revision of infected hip arthroplasties at preserving cemented and cementless stems.
MATERIALS AND METHODS
Between December 2001 and February 2017, Inje University Sanggye Paik Hospital treated 45 cases of deep infections following hip arthroplasty with a two stage revisional arthroplasty using antibiotics-loaded cement spacers. This approach was applied in an effort to preserve the previously implanted femoral stem. Of these 45 cases, 20 were followed-up for at least two years and included in this analysis. Perioperative clinical symptoms, radiological findings, function and complications during insertion of an antibiotics-loaded cement spacer were analyzed in this study.
RESULTS
Peri-prothetic infections were controlled in 19 of the 20 included cases. Clinical outcomes, as assessed using the Harris hip score, Western Ontario and McMaster University score, also improved. Importantly, similarly improved outcomes were achieved for both cemented and cementless femoral stems.
CONCLUSION
In cases of deep infection following hip arthroplasty, two-stage revision arthroplasty to preserve the previously implanted femoral stem (cemented or cementless) effectively controls infections and preserves joint function.

Keyword

Infected hip arthroplasty; Femoral stem; Harris hip score; Western Ontario and McMaster University score; Two-stage revision

MeSH Terms

Arthroplasty*
Hip
Joints
Ontario

Figure

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  Fig. 1 Flowchart of case selection and analysis.ALCS: antibiotics-loaded cement spacer, f/u: follow-up.

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  Fig. 2 The cement spacer was molded into the shape of a hemiarthroplasty. (A) The spacer consists of a bipolar head, shell, and antibiotics-mixed cement. (B) Prosthesis fitted over the sterilized head according to the size of the retrieved acetabular cup. (C) The spacer was molded into the required shape.

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  Fig. 3 (A) The molded cement spacer was attached to the retained femoral stem and attached to the trunnion of the femoral neck. (B) An 80-year-old female with an antibiotics-loaded cement spacer inserted into a cementless femoral stem. (C) A 75-year-old female with an antibiotics-loaded cement spacer inserted into a cemented femoral stem.

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  Fig. 4 Harris hip and WOMAC scores; Interval changes of Harris hip and WOMAC score in all patients.WOMAC score: Western Ontario and McMaster University score, ALCS: antibiotics-loaded cement spacer.

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  Fig. 5 Comparing interval changes of WOMAC scores in cemented and cementless stem groups.WOMAC score: Western Ontario and McMaster University score, ALCS: antibiotics-loaded cement spacer.

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  Fig. 6 Comparing interval changes of Harris hip scores in cemented and cementless stem groups.ALCS: antibiotics-loaded cement spacer.

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