Top

International Orthopaedics

Published in:

Open Access 01-11-2017 | Original Paper

Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer

Authors: Dariusz Marczak, Marek Synder, Marcin Sibiński, Michał Polguj, Julian Dudka, Jacek Kowalczewski

Published in: International Orthopaedics | Issue 11/2017

Abstract

Purpose

The aim of this study was to compare two methods of two-stage surgery for PJI (periprosthetic joint infection) after THA (total hip arthroplasty): one with and one without the use of an antibiotic-loaded cement spacer.

Methods

This retrospective study was performed on 99 consecutive patients (99 hips) with a minimum follow-up of 24 months. Patients were divided into two groups: (1) in whom the operation was performed using a spacer, and (2) for whom a spacer was not used.

Results

For the whole cohort, the results improved between pre-operative and final follow-up. Recurrence of infection was found in nine out of 98 patients (9.2%) and was not significantly different between the two groups. Patients treated with a spacer had better functional improvement in the interim period, but the VAS score was better in the non-spacer group. The improvement in final function was better in the spacer group with regard to HHS, but not according to WOMAC score or VAS at final follow-up.

Conclusion

The resection arthroplasty should be awarded particular consideration in cases of poor soft tissue quality, bone stock deficiency, when complications related to spacer use are expected or chances of new hip endoprosthesis implantation are low.

Klouche S, Leonard P, Zeller V, Lhotellier L, Graff W, Leclerc P et al (2012) Infected total hip arthroplasty revision: one- or two-stage procedure? Orthop Traumatol Surg Res 98:144–150CrossRefPubMed

Kunutsor SK, Whitehouse MR, Lenguerrand E, Blom AW, Beswick AD (2016) Re-infection outcomes following one- and two-stage surgical revision of infected knee prosthesis: a systematic review and meta-analysis. PLoS One 11:e0151537CrossRefPubMedPubMedCentral

Pattyn C, De Geest T, Ackerman P, Audenaert E (2011) Preformed gentamicin spacers in two-stage revision hip arthroplasty: functional results and complications. Int Orthop 35:1471–1476CrossRefPubMed

Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95–B(11):1450–1452

Ji B, Xu B, Guo W, Rehei A, Mu W, Yang D, Cao L (2017) Retention of the well-fixed implant in the single-stage exchange for chronic infected total hip arthroplasty: an average of five years of follow-up. Int Orthop 41(5):901–909

Cabrita HB, Croci AT, Camargo OP, Lima AL (2007) Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer. Clinics (Sao Paulo) 62:99–108CrossRef

Jahoda D, Sosna A, Landor I, Vavrík P, Pokorný D, Hudec T (2003) Two-stage reimplantation using spacers--the method of choice in treatment of hip joint prosthesis-related infections. Comparison with methods used from 1979 to 1998. Acta Chir Orthop Traumatol Cech 70:17–24PubMed

Duncan CP, Beauchamp C (1993) A temporary antibiotic-loaded joint replacement system for management of complex, infections involving the hip. Orthop Clin North Am 24:751–759PubMed

Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755CrossRefPubMed

10.

Klässbo M, Larsson E, Mannevik E (2003) Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol 32:46–51CrossRefPubMed

11.

Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE (2004) Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am 86:1989–1997CrossRefPubMed

12.

Kliushin NM, Ermakov AM, Malkova TA (2017) Chronic periprosthetic hip infection: micro-organisms responsible for infection and re-infection. Int Orthop [Epub ahead of print]

13.

Nelson CL, Jones RB, Wingert NC, Foltzer M, Bowen TR (2014) Sonication of antibiotic spacers predicts failure during two-stage revision for prosthetic knee and hip infections. Clin Orthop Relat Res 472:2208–2214CrossRefPubMedPubMedCentral

14.

Sorlí L, Puig L, Torres-Claramunt R, González A, Alier A, Knobel H, Salvadó M, Horcajada JP (2012) The relationship between microbiology results in the second of a two-stage exchange procedure using cement spacers and the outcome after revision total joint replacement for infection: the use of sonication to aid bacteriological analysis. J Bone Joint Surg Br 94:249–253CrossRefPubMed

15.

Mariconda M, Ascione T, Balato G, Rotondo R, Smeraglia F, Costa GG, Conte M (2013) Sonication of antibiotic-loaded cement spacers in a two-stage revision protocol for infected joint arthroplasty. BMC Musculoskelet Disord 14:193CrossRefPubMedPubMedCentral

16.

Pagnano MW, Trousdale RT, Hanssen AD (1997) Outcome after reinfection following reimplantation hip arthroplasty. Clin Orthop 338:192–204CrossRef

17.

Castellanos J, Flores X, Llusa M, Chiriboga C, Navarro A (1998) The Girdlestone pseudarthrosis in the treatment of infected hip replacements. Int Orthop 22:178–181CrossRefPubMedPubMedCentral

18.

Schröder J, Saris D, Besselaar PP, Marti RK (1998) Comparison of the results of the Girdlestone pseudarthrosis with reimplantation of a total hip replacement. Int Orthop 22:215–218CrossRefPubMedPubMedCentral

19.

Blomfeldt R, Kasina P, Ottosson C, Enocson A, Lapidus LJ (2015) Prosthetic joint infection following hip fracture and degenerative hip disorder: a cohort study of three thousand, eight hundred and seven consecutive hip arthroplasties with a minimum follow-up of five years. Int Orthop 39:2091–2096CrossRefPubMed

20.

Takigami I, Ito Y, Ishimaru D, Ogawa H, Mori N, Shimizu T, Terabayashi N, Shimizu K (2010) Two-stage revision surgery for hip prosthesis infection using antibiotic-loaded porous hydroxyapatite blocks. Arch Orthop Trauma Surg 130:1221–1226CrossRefPubMed

Title: Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer
Authors: Dariusz Marczak
Marek Synder
Marcin Sibiński
Michał Polguj
Julian Dudka
Jacek Kowalczewski
Publication date: 01-11-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 11/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3500-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2017

Three dimensionalCT analysis of femoral tunnel position after ACL reconstruction. A prospective study of one hundred and thirty five cases

Incidence and risk factors for symptomatic spinal epidural haematoma following lumbar spinal surgery

How safe and effective is denosumab for bone giant cell tumour?

In regards to the article by Gamba et al.: “Which immobilization is better for distal radius fracture? A prospective randomized trial”

The push-through total femoral prosthesis offers a functional alternative to total femoral replacement: a case series

Computer aided planning of orthopaedic surgeries: the definition of generic planning steps for bone removal procedures