Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer.
OBJECTIVE
Our purpose was to compare 2 methods of treatment of chronic infection in hip arthroplasties--with or without an antibiotic-loaded cement spacer.


METHODS
In a prospective study, we treated 68 infected hip arthroplasties with discharging sinuses and bone loss, comparing 30 patients treated in 2 stages without the use of a spacer (control group) and 38 patients treated with a vancomycin-loaded spacer (study group). The average follow-up was 4 years (2-8.5 years). One patient died of unrelated causes 4 months after first-stage surgery and was excluded from the study.


RESULTS
The 2-stage surgery without spacer controlled the infection in 66.7% of patients, and the 2-stage surgery using the spacer controlled it in 89.1% (P < 0.05). At last follow-up, the average Harris Hip Score increased from 19.3 to 69.0 in the control group versus 19.7 to 75.2 in the study group (P > 0.05). The average leg length discrepancy was 2.6 cm in the control group and 1.5 cm in the study group (P < 0.05). The patients treated with a spacer had better clinical results (81.5% of patients with good results against 60.0% for the control group).


CONCLUSIONS
The use of an antibiotic-loaded spacer in the 2-stage treatment of infected hip arthroplasties provides better infection control with good functional results and is superior to treatment in 2 stages without a spacer.


METHODS
Therapeutic study, Level I-1.
Cabrita
Henrique Berwanger
HB
Department of Orthopedics, Medical School, São Paulo University, São Paulo, SP, Brazil. henriquecabrita@uol.com.br
Croci
Alberto Tesconi
AT
Camargo
Olavo Pires de
OP
Lima
Ana Lúcia Lei Munhoz de
AL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001424:Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D001843:Bone Cements / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology
D000900:Anti-Bacterial Agents; D001843:Bone Cements