Two-Stage Revision Hip Arthroplasty with or without the Use of an Interim Spacer for Managing Late Prosthetic Infection: A Systematic Review of the Literature

Abstract

The aim of the present paper was to identify, appraise, and synthesize the available evidence on two-stage revision hip arthroplasty with or without the use of an interim spacer for managing late prosthetic infection. The review methodology was designed by referencing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and flow diagram, and a Population, Intervention, Comparator, Outcomes and Study (PICOS) design framework was used to search for studies to incorporate within the review. Two independent investigators were involved in searching for relevant articles that fulfilled the inclusion criteria for the study. Critical appraisal of the selected articles was carried out using the relevant Critical Appraisal Skills Programme checklists. From an initial pool of 125 articles, four studies satisfied the inclusion criteria and quality assessment and were included for final review. Two patient groups were identified from within the selected studies: spacer and non-spacer. Both groups were assessed in terms of functional outcome, infection cure rates, and technical difficulties encountered during treatment. Better functional outcome was reported in the spacer group, both in the interim period between the two stages and after completion of treatment. The use of spacers reduced operative difficulty during the second stage and accelerated patient discharge. Reinfection and infection persistence rates were higher in the non-spacer group. Within the spacer group, articulated spacers performed better in all parameters. The results of this review reinforce the available evidence supporting the use of interim hip spacers in revision hip arthroplasty for managing prosthetic infection and also indicate that articulated hip spacers could be an attractive option going forward.

Keywords: Arthroplasty; Hip; Infection; Revision.

Fig. 1

Flow diagram summarizing the literature search and screening process.

Fig. 2

Trends in hip scores across two review studies. (A) Trends in Harris hip scores (Marczak et al.). (B) Trends in Western Ontario and McMaster Universities Arthritis Index (Marczak et al.). (C) Trends in visual analog scale (Marczak et al.). (D) Trends in Harris hip scores (Hseih et al.).

Fig. 3

Comparison of functional outcomes among control and treatment groups at final follow‐up in one study (Cabrita et al. ²⁵ ). HSS, Harris hip score.

Fig. 4

Overall number of patients with recurrence of infection in treatment and control groups across the review studies.

Fig. 5

Chief complications and frequency reported in treatment and control groups.