title: An articulating antibiotic spacer controls infection and improves pain and function in a degenerative septic hip.
abstract: BACKGROUND
  Treating septic arthritis of the hip with coexisting advanced degenerative disease is challenging. The use of primary total hip arthroplasty (THA) has led to postoperative infection rates as high as 22%. Insertion of antibiotic spacers with subsequent reimplantation of a THA controls infection and improves pain and function in patients with periprosthetic infections.
  
  
  OBJECTIVE
  We asked whether two-stage exchange for patients with degenerative joint disease (DJD) and coexisting septic arthritis would control infection and improve pain relief and function both during the period after insertion of the spacer and after conversion to THA.
  
  
  METHODS
  We retrospectively reviewed 14 patients with severe DJD and either active or recent septic arthritis treated with débridement and insertion of a primary antibiotic-loaded cement spacer between 1996 and 2008. Ten patients underwent subsequent exchange to a permanent hip arthroplasty. Four patients did not undergo exchange to a permanent THA: two died from unrelated causes and two elected not to proceed with exchange because their spacer provided adequate function. We obtained a modified Harris hip score. The minimum clinical followup was 7 months (average, 28 months; range, 7-65 months) after insertion of the spacer.
  
  
  RESULTS
  Mean pain scores improved from 6 to 34, and overall Harris hip scores improved from 11 to 67 at last followup with the spacer. Those who underwent definitive THA had further improvement in their mean Harris hip scores to 93.
  
  
  CONCLUSIONS
  Articulating antibiotic spacers offer acceptable pain relief and function while the infection is treated in this unique group of patients.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic Arizona, 5777 Mayo Boulevard, Phoenix, AZ 85054, USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Fleck
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Spangehl
authors.forename: Venkat R
authors.initials: VR
authors.lastname: Rapuri
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Beauchamp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001170:Arthritis, Infectious / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001843:Bone Cements / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006304:Health Status; D006621:Hip Joint / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D016459:Prosthesis-Related Infections / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D014031:Tobramycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins; D014031:Tobramycin