Use of articulating antibiotic loaded pre-designed spacer in two-staged revisions for infected total hip arthroplasties: A retrospective long-term outcome study

Background

With the increasing number of total hip arthroplasties performed across the world, there is a noted rise in the number of prosthetic joint infections. Two-staged revisions are the most accepted interventions for these. There are two forms of interim antibiotic spacers - hand-made and prefabricated. There is paucity of long-term data to support the use of the latter. The purpose of our retrospective study was to analyse the long-term results of the same.

Methods

Out of 45 patients treated by two-staged revision for prosthetic hip joint infections, 31 underwent implantation of prefabricated antibiotic-loaded spacer in the first stage (June 2011–October 2020). The primary objective was to determine the recurrence rate of infection, and secondary objectives were analysis of outcome, time for infection eradication, and review of complications encountered. Minimal follow-up was 1 year and maximum was 8 years (mean 48.02 months).

Results

29 patients underwent both the stages of the revision procedure. None had infection recurrence. 2 died before the second stage. Long term (5 years) mortality was 8.6 %. Mean interval between the 1st and 2nd stage surgeries was 16.5 weeks. 2 patients had spacer dislocations; one required an open reduction. 1 patient had a fracture during the 2nd stage, and 3 had dislocations after the 2nd stage.

Conclusion

Prefabricated antibiotic loaded spacer remains a promising option in dealing with prosthetic hip joint infections. Our experience and long-term follow-up results depicts low complication rate of the procedure whilst facilitating long-term infection control and nil infection recurrence rate.