Title : Long-term results from the use of a pre-fabricated articulating antibiotic-loaded cement spacer (Spacer G) in two-stage revisions for infected total hip replacements
Abstract:
Background: Approximately 1% patients undergoing total hip replacement (THR) will develop a prosthetic joint infection, carrying a considerable burden of morbidity and mortality. Pre-fabricated articulating antibiotic-loaded cement spacers can be used in the treatment of infected total hip replacements, but there remains little long-term data to support their use.
Methods: Completed analysis of 29 patients who underwent a two-stage revision for prosthetic joint infection between June 2011 and October 2020. All patients had the Spacer G (loaded with gentamicin and vancomycin) utilised in the first stage.
Results: Mean follow-up period was 50.5 months (range 1-112 months). Intraoperative cultures showed no growth in 11 patients, whilst positive cultures were obtained in 18. All patients underwent a prolonged course of antibiotic treatment after the first stage. The mean CRP before the first stage was 97.4 (range 11.1-367.4), falling to 25.0 (range 1-64) at the second stage. The mean time between the first and second stages was 24 weeks (range 4-82 weeks). Intra-operative sampling during the second stage revealed no growth in 27 of 28 patients. 22 patients had post-operative antibiotics after the second stage. 21 patients remain alive, whilst 8 passed away a mean of 60.3 months after the first stage (range 1-112 months). 28 patients reached the second stage, all but one remained infection-free for the duration of follow-up.
Conclusion: Pre-fabricated antibiotic-loaded articulating cement spacers can be useful when managing infected THR with long-term follow-up data showing that they carry a low risk of complications and can facilitate long-term infection control.
