Staged Revision of Infected Hip Arthroplasty Using an Antibiotics-Loaded Intra-Articular Cement Spacer with Retention of the Stem

Yerl-Bo Sung; Jong Seok Oh

doi:10.5371/jkhs.2010.22.1.66

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Sung and Oh: Staged Revision of Infected Hip Arthroplasty Using an Antibiotics-Loaded Intra-Articular Cement Spacer with Retention of the Stem

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2010; 22(1): 66-72.

Published online: 31 March 2010

DOI: https://doi.org/10.5371/jkhs.2010.22.1.66

Staged Revision of Infected Hip Arthroplasty Using an Antibiotics-Loaded Intra-Articular Cement Spacer with Retention of the Stem

Yerl-Bo Sung, MD, Jong Seok Oh, MD

Department of Orthopedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University, Seoul, Korea.

Address reprint request to Yerl-Bo Sung, MD. Department of Orthopaedic Surgery, Sang-Gye Paik Hospital, Inje University, 761-1 Sang-Gye 7-dong, Nowon-gu, Seoul 139-707, Korea. TEL: +82-2-950-1032, FAX: +82-2-934-6342, ybs58@paik.ac.kr

Received 27 July 2009 Revised 20 October 2009 Accepted 30 November 2009

Abstract

Purpose

When the femoral stem was well fixed in patients with a deep prosthetic hip infection, the authors performed a two-stage revision procedure using antibiotic-loaded cement spacers (ALCS) without removal of the stem, and the efficacy of this treatment was assessed.

Materials and Methods

For 12 cases of infected hip arthroplasties, a two-stage procedure was performed, and the patients were followed up for over 2 years. After the acetabular component and head was removed, debridement was done. The molded ALCS was inserted. Revision was then performed after eradication of the infection. The results were analyzed, including the changes in the clinical manifestation, the radiologic findings, the laboratory results, the functional score and the complications.

Results

Of all 12 cases, the two-stage revision arthroplasty using an ALCS with retention of the stem was performed in 11 cases (92%), on an average of 66 days (range: 40~152 days). In the 11 revised cases, there was no evidence of recurrence of infection. In the 11 cases, the mean Harris hip score improved from 40.1 points preoperatively to 91.8 points at last the follow-up. The mean WOMAC score improved from 41.8 points preoperatively to 81 points at the last follow-up. The mean Harris hip score was 85.3 points and the WOMAC score was 72.4 points during the ALCS insertion-period.

Conclusion

For the case of a perioprosthetic hip infection with a well-fixed femoral stem, two-staged revision using an ALCS without stem removal could be an alternative method in terms of effective infection control and preservation of the joint function.

Keywords: Infected hip arthroplasty, Antibiotic-loaded cement spacer, Retention of stem, Staged revision

Figures and Tables

Fig. 1

Molding process of antibiotics loaded cement spacer. (A) The spacer consists of a bipolar head, shell and antibiotics-mixed cement. (B) An antibiotics-loaded intra-articular cement spacer was made using an artificial head and a bipolar shell as a mold. (C) This photograph shows the molded spacer. (D) The spacer was assembled to the trunnion of the femoral neck.

Fig. 2

Functional scores were improved compared to that of preoperative period.

Fig. 3

A 77-year-old female underwent bipolar hemiarthroplasty due to fracture of left femur neck. (A) This radiograph taken at a month after the index operation shows the stem stable and well-fixed. But MRCNS was identified in hip joint aspirate-culture. (B) An antibiotics-loaded cement spacer was inserted after thorough debridement, but well-fixed femoral stem was retained. (C) This radiograph taken at 2 years after the second stage revision shows no evidence of periprosthetic osteolysis and implant-loosening.

Table 1

Summary of Cases.

^*BHA: Bipolar Hemiarthroplasty, ^†THRA: Total Hip Replacement Arthroplasty, ^‡MRSA: Methicillin Resistant Staphylococcus Aureus, ^§MRCNS: Methicillin Resistant Coagulase Negative Staphylococcus, ^∥MSSE: Methicillin-Sensitive Staphylococcus Epidermidis, ^¶DM: Diabetes Mellitus, ^**HTN: Hypertension

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