title: Acetabular spacers in 2-stage hip revision: is it worth it? A single-centre retrospective study.
abstract: OBJECTIVE
  The aim of this work is to evaluate an acetabular antibiotic loaded bone cement spacer in 2-stage revision surgery as a potential approach able to reduce complications during the inter-stage period (i.e. dislocation, acetabular wear), as well as simplify 2-stage hip revision surgery and improve hip biomechanics.
  
  
  METHODS
  We performed a retrospective comparative study and evaluated clinical, radiological and surgical data of 71 patients affected by periprosthetic hip infection who were treated with 2-stage exchange. 31 patients were treated using an acetabular spacer in addition to the femoral (group A) while 40 underwent a standard revision surgery (femoral spacer only, group B).
  
  
  RESULTS
  Mean time of surgery for the first stage was 148 ± 59 minutes and 142 ± 45 minutes for group A and B respectively; we noted a statistically significant reduction (26 min, p = 0.015) in the same parameter for the second stage (83 ± 35 minutes for group A and 109 ± 36 minutes for group B). We observed the following interstage complications: 5 femoral spacer dislocations (1 for group A and 4 for group B); 1 spacer fracture (group B), 1 spacer fracture (group A), 2 periprosthetic fractures (group B) and 2 patients with acetabular spacer instability (group B). Additionally, we observed a significant improvement in leg length restoration for group A (p = 0.03).
  
  
  CONCLUSIONS
  Our data show that the acetabular spacer technique is able to reduce the interstage complication rate and allow improved hip biomechanics restoration.
authors.affiliation: Infectious Diseases and Septic Orthopaedics, Hospital St. Mary of Mercy, Albenga - Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Burastero
authors.affiliation: Orthopaedic Clinic - IRCCS University Hospital San Martino IST, Genova - Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Basso
authors.affiliation: Infectious Diseases and Septic Orthopaedics, Hospital St. Mary of Mercy, Albenga - Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Carrega
authors.affiliation: Orthopaedic Clinic - IRCCS University Hospital San Martino IST, Genova - Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cavagnaro
authors.affiliation: Orthopaedic Clinic - IRCCS University Hospital San Martino IST, Genova - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chiarlone
authors.affiliation: Infectious Diseases and Septic Orthopaedics, Hospital St. Mary of Mercy, Albenga - Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salomone
authors.affiliation: Orthopaedic Clinic - IRCCS University Hospital San Martino IST, Genova - Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Papa
authors.affiliation: Orthopaedic Clinic - IRCCS University Hospital San Martino IST, Genova - Italy.
authors.forename: Lamberto
authors.initials: L
authors.lastname: Felli
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements / Q000494:pharmacology*; D015331:Cohort Studies; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004343:Drug Implants