title: Similar rate of infection eradication for functional articulating, prefabricated and custom-made spacers in 2-stage revision of the infected total hip: a literature review.
abstract: BACKGROUND
  2-stage revision with the use of an antibiotic-loaded interval spacer is therapy of choice in late periprosthetic joint infection for most surgeons. For the spacer, either a prefabricated, functional articulating or custom-made spacer can be used. Little is known about which type of spacer provides optimal outcome after 2-stage revision. The aim of this study was to determine which type of spacer provides the best results, when used in 2-stage revision of an infected THA.
  
  
  METHODS
  We performed a systematic review of the literature to analyse which type of interval spacer provides highest infection eradication rate and best functional outcome after a minimum 2 year follow-up. Exclusion criteria were follow-up of less than 2 years, single-stage revision, or 2-stage revision without use of a spacer.
  
  
  RESULTS
  25 studies were included. Infection eradication rate was similar with rates of 96%, 93% and 95% for the prefabricated-, functional articulating- and custom-made spacers respectively. Functional outcome was scarcely described. Postoperative HHS was 81, 90 and 83 respectively.
  
  
  CONCLUSIONS
  Functional articulating spacers achieve a comparable rate of infection eradication in the treatment of periprosthetic hip joint infections as compared to preformed or custom-made antibiotic-loaded spacers. There is insufficient evidence concerning rehabilitation and functional outcome after 2-stage revision hip arthroplasty to advocate or discourage the use of either kind of interval spacer.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Joint Research, OLVG, Amsterdam - The Netherlands.
authors.forename: Ewout S
authors.initials: ES
authors.lastname: Veltman
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Joint Research, OLVG, Amsterdam - The Netherlands.
authors.forename: Dirk Jan F
authors.initials: DJ
authors.lastname: Moojen
authors.affiliation: Department of Orthopaedic Surgery, Medical University Hospital Graz, Graz - Austria.
authors.forename: Mathias
authors.initials: M
authors.lastname: Glehr
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Joint Research, OLVG, Amsterdam - The Netherlands.
authors.forename: Rudolf W
authors.initials: RW
authors.lastname: Poolman
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip; D006622:Hip Prosthesis; D006801:Humans; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000628:therapy*; D020127:Recovery of Function; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents