Septic two stage hip revision – Evaluation of a new spacer technique using original prosthesis implants

Abstract text (incl. references and figure legends)

Background:

In septic two-stage revision hip arthroplasty widespread concepts comprise the installation of a Girdlestone-situation or the use of prefabricated PMMA-spacers. These techniques show complications such as abrasio of bone-cement particles, dislocation, soft tissue contractures or periprosthestic fractures. To counter these complications a new spacer technique has been proposed where new original prostheses are implanted using an inferior cementation technique. To date, the use of regular implant components as a spacer was accompanied by concerns of a higher risk of infection or complications during explantation. We evaluated this novel technique with respect to complication rate and its infection-related non-inferiority.

Methods:

Retrospective evaluation of periprosthetic joint infections was performed according to the 2014 MSIS criteria. Radical surgical debridement was performad after prosthesis explantation. A new femoral shaft was coated with PMMA cement that had been individually loaded with antibiotics. Before implantation, the shaft was covered with the patient's blood and cement was only used at 6 minutes. This ensured impaired iterdigitation for easier later removal. On the acetabular side a polyethylene cup was cemented into a cage fixed with screws.

Results:

A total of 130 patients was evaluated with a median follow-up of five years. The rate of reinfection-free patients during follow-up was around 92%. Complication rate of this spacer technique was about 10% (9% dislocation, 1% peri-implant fracture).

Conclusion:

The 5-year reinfection-free rate of 92% is at a comparable level as in other reported techniques. The 10% complication rate is low. The described results thus appear very promising. Advantages of such a novel technique should be a better soft tissue management with a higher range of motion postoperatively.

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