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Review
. 2009 Sep 3;6(5):274-9.
doi: 10.7150/ijms.6.274.

Mechanical complications and reconstruction strategies at the site of hip spacer implantation

Konstantinos Anagnostakos  1 , Jochen Jung, Nora Verena Schmid, Eduard Schmitt, Jens Kelm
Affiliations
Review

Mechanical complications and reconstruction strategies at the site of hip spacer implantation

Konstantinos Anagnostakos et al. Int J Med Sci. .

Abstract

Over the past two decades antibiotic-impregnated hip spacers have become a popular procedure in the treatment of hip joint infections. Besides infection persistence and/or reinfection, major complications after hip spacer implantation include spacer fracture, -dislocation, and bone fracture. Moreover, in cases with extensive loss of femoral and/or acetabular bone alternative reconstructive techniques should be used for a stable spacer fixation and prevention of fractures or dislocations. The present article reviews the different types of spacer fractures and dislocations and offers some suggestions about reconstructive techniques for management of extensive loss of femoral and/or acetabular bone at the site of hip spacer implantation.

Keywords: femoral fracture; hip spacers; reconstruction.; spacer dislocation; spacer fracture.

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Conflict of interest statement

Conflict of Interest: The authors have declared that no conflict of interest exists.

Figures

Figure 1
Figure 1
Articulating hip spacer in situ, the spacer stem is inserted into the femur according to a “press-fit” method.
Figure 2
Figure 2
Articulating hip spacer in situ, the partial cementation of the spacer onto the proximal femur provides a rotational stability; at prosthesis reimplantation, the spacer can be removed at one piece, leaving no cement particles in the femoral canal.
Figure 3
Figure 3
Articulating hip spacer consisting of a spacer cup and -stem.
Figure 4
Figure 4
Spacer migration into the pelvis due to acetabular defects.
Figure 5
Figure 5
Symptomatic spacer neck fracture with dislocation in situ.
Figure 6
Figure 6
Asymptomatic spacer fracture localised in the middle part of the spacer stem with no dislocation of the spacer.
Figure 7
Figure 7
Antibiotic-loaded hip spacer with a metallic endoskeleton for enhancement of the mechanical properties.
Figure 8
Figure 8
Left: Femoral fracture at the site of hip spacer implantation. Right: Treatment consisted of spacer removal, and insertion of a cement-coated modular prosthesis with a spacer head. The cement mantle of the prosthesis is also antibiotic-loaded according to the sensitivity profile of the causative organism. After infection eradication, the spacer head has been removed and a metallic head with an acetabular cup implanted. This procedure offers a stable fracture treatment and facilitates the prosthesis reimplantation regarding shorter surgery time, less blood loss and no need for femoral exposure. The remaining intrapelvic cement has no disadvantage regarding the infection eradication and might be associated with severe intraoperative complications in case of a removal trial.
Figure 9
Figure 9
Large osseous defect of the proximal femur following extensive prosthesis loosening. Treatment consisted of prosthesis removal, debridement, pulsatile lavage, and insertion of a long femoral nail with an antibiotic-loaded cement mantle and a spacer on top.
See this image and copyright information in PMC

References

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MeSH terms