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. 2021 Sep 4;10(9):1073.
doi: 10.3390/antibiotics10091073.

New Technique for Custom-Made Spacers in Septic Two-Stage Revision of Total Hip Arthroplasties

Moritz Mederake  1 , Ulf Krister Hofmann  1 , Bernd Fink  2   3
Affiliations

New Technique for Custom-Made Spacers in Septic Two-Stage Revision of Total Hip Arthroplasties

Moritz Mederake et al. Antibiotics (Basel). .

Abstract

The choice of spacer in the interim phase of two-stage revision hip arthroplasty is crucial. Conventional concepts like a Girdlestone situation, handformed or preformed bone cement spacers show complications like soft-tissue contractions, abrasion of bone cement particles, dislocation, breakage and a low level of mobility in the interim phase. To address these disadvantages, the senior author developed a new technique for custom-made spacers in septic two-stage revision of total hip arthroplasties using prosthetic implants with individualized antibiotic mixture in the cement applying a mechanical inferior cementation method. The aim of this study was to evaluate the results of these spacers with respect to their non-inferiority in terms of reinfection and survival-rate of the new implant and to describe the complications associated with this procedure. Our collective consisted of 130 patients with a median follow-up of nearly five years. With a reinfect-free rate of 92% and a spacer-related complication rate of 10% (8% articular dislocation, 1% periprosthetic joint fracture, 1% breakage), this procedure seems to be safe and superior regarding complications compared to conventional concepts. Further studies are necessary to show the clinical benefit of this procedure.

Keywords: spacer-periprosthetic joint infection-hip arthroplasty-two-stage revision-antibiotic therapy-orthopedic infections-bone and joint infections.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Case with an endofemoral explantation followed by the interim prosthesis and reimplantation. (a): Preoperative situation with infected Zweimueller stem. (b): After endofemoral explantation of the infected prosthesis, the interim prosthesis was implanted consisting of a cemented stem and acetabular a Ganz-ring with a Müller flat-profile cup (ZimmerBiomet, Winterthur, Switzerland). (c): Situation after reimplantation of the definitive prosthesis consisting of Allofit S-cup and Revitan stem (ZimmerBiomet, Winterthur, Switzerland).
Figure 2
Figure 2
Case with a transfemoral explantation because of a fully osteointegrated prosthetic stem, which was not possible to explant endofemorally. (a): Preoperative situation with infected CLS-stem (ZimmerBiomet, Winterthur, Switzerland). (b): After transfemoral explantation of the infected prosthesis the interim prosthesis was implanted consisting of a Weber-Stem and acetabular a Ganz-ring with a Müller flat-profile cup (ZimmerBiomet, Winterthur, Switzerland). The Ganz-ring was fixed with only three screws. The transfemoral flap was refixed with 1.5 mm diameter cerclages. (c): Situation after reimplantation of the definitive prosthesis consisting of an Allofit S-cup and a Revitan stem (ZimmerBiomet, Winterthur, Switzerland).
Figure 3
Figure 3
Kaplan–Meier curve for the proportion of patients free from reinfection.
See this image and copyright information in PMC

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