Title : One and a half-stage total hip arthroplasty with custom-made articulating spacers (CUMARS) for management of bilateral destructive hip septic arthritis – A case report
Abstract:
Prompt diagnosis and management of septic arthritis (SA) are pivotal for early infection eradication, joint preservation and prevention of quality-of-life impact consequences. In severe hip joint destruction, resection arthroplasty has the benefit of effective infection eradication but limitation of poor functional outcomes. Therefore, total hip arthroplasty (THA) was introduced for aims to eradicate infection while preserving hip function. Few studies have been done on two-stage exchange THA for management of native hip SA using primary Prosthesis with Antibiotic-Loaded Acrylic Cement (PROSTALAC) articulating spacer with generally good outcomes. However, a small percentage of patients electively chose not to proceed with the second surgery – two-stage exchange arthroplasty. 1.5-stage THA has the benefits of cost effectiveness, satisfactory functional outcomes whilst eliminating the physical and psychological burden of a repeat operation, especially in frail elderly patients. However, studies on 1.5-stage THA have been established in infected THA management, but not in native hip SA. Comparing spacer types, PROSTALAC is a semi-constraint implant with limited sizes that was designed to remain in-situ short-term with a second-stage exchange after while Custom-Made Articulating Spacers (CUMARS) has no constraints, are more readily available and was designed to be a functional single stage THA that can remain permanent yet not preclude the possibility of a second-stage exchange THA if required. Overall, this led to the consideration of 1.5-stage THA using CUMARS for management of chronic destructive hip SA. We report a 67-year-old patient with functional decline from fully independent without aids to chairbound over eight months. Work-up revealed raised inflammatory markers and bilateral destructive hip SA. He underwent bilateral 1.5-stage THA with antibiotic-loaded CUMARS. One-year post-operation, he remains infection free and is progressing well with rehabilitation – ambulating independently with walking frame. Management of SA varies largely depending on infection duration, activity level and extent of joint destruction. In a significantly deformed hip joint due to SA, 1.5-stage THA using CUMARS is a viable option with the benefits of effective infection eradication, cost-effectiveness, reduced physical and psychological burden in avoiding a second operation, all whilst not precluding the possibility of a second-stage exchange THA if required with ease.
What will audience learn from your presentation?
- For consideration of 1.5-stage total hip arthroplasty using antibiotic-loaded custom-made articulating spacers as a viable option for management of severe destructive hip septic arthritis for the benefits of effective infection eradication, cost-effectiveness, reduced physical and psychological burden on patients in avoiding a second surgery, yet not precluding the option of a second stage if required with ease.
