title: Preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty. Long-term results.
abstract: Two-stage revision is the most widely accepted and performed intervention for chronically infected hip prosthesis and different interim spacers have been proposed. In recent years, antibiotic-loaded preformed spacers have become available on the market. The aim of this retrospective study was to assess the long-term results of two-stage revision with preformed spacers and uncemented hip prosthesis for the treatment of septic hip prosthesis. From 2000 to 2010, 183 consecutive patients underwent two-stage revision of septic hip prosthesis, with a same protocol, including preformed antibiotic-loaded cement spacer and a cementless modular hip revision prosthesis and four to six weeks antibiotic administration. Clinical and radiologic assessment at a minimum follow-up of two years was performed. At a minimum two years follow-up, 10 patients (5.4%) had had an infection recurrence, four (2.2%) an aseptic loosening and four more required partial revision of the modular components of the prosthesis, because of hip instability/dislocation; 21 patients died or were lost to follow-up. Considering all the reasons for revision, survivorship at eleven years was 93.9%. Harris Hip Score improved from 29.1 ± 14.6 pre-operatively to 41.1 ± 15.9 after spacer implant and 81.7 ± 17.6 after hip revision. The main complications after spacer implant included: spacer dislocation (16.4%), intra-operative femoral fractures (2.7%), and thromboembolism (2.1%). Complications after hip revision were: instability/dislocation (4,3%), intra-operative femoral fractures (1.6%), and thromboembolism (3.3%). Two-stage revision of septic hip prosthesis with preformed antibiotic-loaded spacers and cementless hip prosthesis provides satisfactory long-term results, with reduced complications.
authors.affiliation: Centre for Reconstructive Surgery and Osteo-articular Infections, IRCCS Galeazzi Orthopaedic Institute, Milan - Italy. carlo.romano@grupposandonato.it
authors.forename: Carlo L
authors.initials: CL
authors.lastname: Romanò
authors.forename: Delia
authors.initials: D
authors.lastname: Romanò
authors.forename: Alessandra
authors.initials: A
authors.lastname: Albisetti
authors.forename: Enzo
authors.initials: E
authors.lastname: Meani
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D001843:Bone Cements / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006304:Health Status; D006621:Hip Joint / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements