Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;35(1):32-39.
doi: 10.5371/hp.2023.35.1.32. Epub 2023 Mar 6.

Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections

Michele Fiore  1 , Claudia Rondinella  1 , Azzurra Paolucci  1 , Lorenzo Morante  1 , Massimiliano De Paolis  1 , Andrea Sambri  1
Affiliations

Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections

Michele Fiore et al. Hip Pelvis. 2023 Mar.

Abstract

Purpose: A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the "gold standard" for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer.

Materials and methods: A retrospective review of 64 consecutive patients was conducted: 34 underwent two-stage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays.

Results: Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9; P<0.001).

Conclusion: The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure.

Keywords: Cement spacers; Hip; Polymethilmetacrilate; Prosthetic joint infections; Two-stage.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST: The authors declare that there is no potential conflict of interest relevant to this article.

Figures

Fig. 1
Fig. 1. (A) Anteroposterior X-rays of the pelvis showing a left hip prosthetic joint infection. (B) The prosthesis was removed and a poly(methyl methacrylate) (PMMA) spacer was implanted. (C) Reimplantations with a cementless total hip arthroplasty.
Fig. 2
Fig. 2. (A) Anteroposterior X-rays of the pelvis showing a left hip prosthetic joint infection. (B) The prosthesis was removed by performance of a spacer-free procedure. (C) Reimplantations with a cementless total hip arthroplasty.
See this image and copyright information in PMC

References

    1. Cabrita HB, Croci AT, Camargo OP, Lima AL. Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer. Clinics (Sao Paulo) 2007;62:99–108. doi: 10.1590/s1807-59322007000200002. - DOI - PubMed
    1. Diamond OJ, Masri BA. Articulating antibiotic impregnated spacers in prosthetic joint infections: where do we stand? Int J Surg. 2018;54(Pt B):345–350. doi: 10.1016/j.ijsu.2017.07.044. - DOI - PubMed
    1. Sandiford NA, Duncan CP, Garbuz DS, Masri BA. Two-stage management of the infected total hip arthroplasty. Hip Int. 2015;25:308–315. doi: 10.5301/hipint.5000265. - DOI - PubMed
    1. Erivan R, Lecointe T, Villatte G, Mulliez A, Descamps S, Boisgard S. Complications with cement spacers in 2-stage treatment of periprosthetic joint infection on total hip replacement. Orthop Traumatol Surg Res. 2018;104:333–339. doi: 10.1016/j.otsr.2017.11.016. - DOI - PubMed
    1. Leunig M, Chosa E, Speck M, Ganz R. A cement spacer for two-stage revision of infected implants of the hip joint. Int Orthop. 1998;22:209–214. doi: 10.1007/s002640050244. - DOI - PMC - PubMed

LinkOut - more resources