title: Does a prefabricated gentamicin-impregnated, load-bearing spacer control periprosthetic hip infection?
abstract: BACKGROUND
  Treating deep infection following THA has been a challenge. While the standard treatment has remained a two-stage revision, spacer designs, incorporated antibiotics, and concentrations have varied. Since control of infection may relate to choice and concentration of antibiotics, it is important to report rates of control from various spacers.
  
  
  OBJECTIVE
  We therefore determined (1) the rate of infection control and (2) complications associated with a prefabricated, load-bearing, gentamicin-impregnated hip spacer in treating periprosthetic infections of the hip.
  
  
  METHODS
  We retrospectively reviewed 33 patients with periprosthetic THA infections treated with a prefabricated, partial load-bearing, gentamicin-impregnated hemiarthroplasty spacer. Thirty of the 33 patients underwent second stage reimplantation after a mean 15 weeks. We collected patient demographic data, laboratory values, infecting organism, size of spacer mold, antibiotic selection, complications, and infection control rates from two academic centers. Recurrent infection at last followup was determined by the presence of physical symptoms or signs or elevated serologic tests. The minimum followup was 24 months (mean, 43 months; range, 24-70 months).
  
  
  RESULTS
  Twenty-eight of the 30 patients who underwent reimplantation remained infection-free at last followup: one patient became reinfected with a different organism secondary to wound problems; one became reinfected with the same organism, but was restaged with the mold used in this study, reimplanted, and subsequently remained free of infection. Two of the 33 patients had persistently elevated inflammatory markers at the completion of their first stage and were restaged with this mold; both underwent reimplantation and remained free of infection at latest followup. One of the 33 patients was satisfied and ambulatory with their spacer mold. There were no major complications.
  
  
  CONCLUSIONS
  Our data supported the use of a partial load-bearing, gentamicin-impregnated hemiarthroplasty spacer in treating deep periprosthetic THA infections.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, 339 Windermere Road, London, ON, N6A 5A5, Canada.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Degen
authors.forename: John R
authors.initials: JR
authors.lastname: Davey
authors.forename: J Roderick
authors.initials: JR
authors.lastname: Davey
authors.forename: James L
authors.initials: JL
authors.lastname: Howard
authors.forename: Richard W
authors.initials: RW
authors.lastname: McCalden
authors.forename: Douglas D R
authors.initials: DD
authors.lastname: Naudie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D016474:Weight-Bearing
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins