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Clinical Orthopaedics and Related Research®

Published in:

01-11-2011 | Symposium: Papers Presented at the 2010 Meeting of the Musculoskeletal Infection Society

An Articulating Antibiotic Spacer Controls Infection and Improves Pain and Function in a Degenerative Septic Hip

Authors: Erin E. Fleck, MD, Mark J. Spangehl, MD, Venkat R. Rapuri, MD, FRCS, Christopher P. Beauchamp, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 11/2011

Abstract

Background

Treating septic arthritis of the hip with coexisting advanced degenerative disease is challenging. The use of primary total hip arthroplasty (THA) has led to postoperative infection rates as high as 22%. Insertion of antibiotic spacers with subsequent reimplantation of a THA controls infection and improves pain and function in patients with periprosthetic infections.

Questions/purposes

We asked whether two-stage exchange for patients with degenerative joint disease (DJD) and coexisting septic arthritis would control infection and improve pain relief and function both during the period after insertion of the spacer and after conversion to THA.

Methods

We retrospectively reviewed 14 patients with severe DJD and either active or recent septic arthritis treated with débridement and insertion of a primary antibiotic-loaded cement spacer between 1996 and 2008. Ten patients underwent subsequent exchange to a permanent hip arthroplasty. Four patients did not undergo exchange to a permanent THA: two died from unrelated causes and two elected not to proceed with exchange because their spacer provided adequate function. We obtained a modified Harris hip score. The minimum clinical followup was 7 months (average, 28 months; range, 7–65 months) after insertion of the spacer.

Results

Mean pain scores improved from 6 to 34, and overall Harris hip scores improved from 11 to 67 at last followup with the spacer. Those who underwent definitive THA had further improvement in their mean Harris hip scores to 93.

Conclusions

Articulating antibiotic spacers offer acceptable pain relief and function while the infection is treated in this unique group of patients.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Title: An Articulating Antibiotic Spacer Controls Infection and Improves Pain and Function in a Degenerative Septic Hip
Authors: Erin E. Fleck, MD
Mark J. Spangehl, MD
Venkat R. Rapuri, MD, FRCS
Christopher P. Beauchamp, MD
Publication date: 01-11-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 11/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-1903-1

At a glance: The STEP trials

Springer Medicine

An Articulating Antibiotic Spacer Controls Infection and Improves Pain and Function in a Degenerative Septic Hip

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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