An Articulating Antibiotic Spacer Controls Infection and Improves Pain and Function in a Degenerative Septic Hip
- 1 November 2011
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics and Related Research
- Vol. 469 (11), 3055-3064
- https://doi.org/10.1007/s11999-011-1903-1
Abstract
Treating septic arthritis of the hip with coexisting advanced degenerative disease is challenging. The use of primary total hip arthroplasty (THA) has led to postoperative infection rates as high as 22%. Insertion of antibiotic spacers with subsequent reimplantation of a THA controls infection and improves pain and function in patients with periprosthetic infections. We asked whether two-stage exchange for patients with degenerative joint disease (DJD) and coexisting septic arthritis would control infection and improve pain relief and function both during the period after insertion of the spacer and after conversion to THA. We retrospectively reviewed 14 patients with severe DJD and either active or recent septic arthritis treated with débridement and insertion of a primary antibiotic-loaded cement spacer between 1996 and 2008. Ten patients underwent subsequent exchange to a permanent hip arthroplasty. Four patients did not undergo exchange to a permanent THA: two died from unrelated causes and two elected not to proceed with exchange because their spacer provided adequate function. We obtained a modified Harris hip score. The minimum clinical followup was 7 months (average, 28 months; range, 7–65 months) after insertion of the spacer. Mean pain scores improved from 6 to 34, and overall Harris hip scores improved from 11 to 67 at last followup with the spacer. Those who underwent definitive THA had further improvement in their mean Harris hip scores to 93. Articulating antibiotic spacers offer acceptable pain relief and function while the infection is treated in this unique group of patients. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Keywords
This publication has 28 references indexed in Scilit:
- A preformed temporary antibiotic-loaded cement spacer for the treatment of destructive septic hip arthritis: a case reportInternational Journal of Infectious Diseases, 2010
- Total hip arthroplasty for patients with osteoarthritis secondary to hip pyogenic infection.2010
- Perioperative Testing for Joint Infection in Patients Undergoing Revision Total Hip ArthroplastyJournal of Bone and Joint Surgery, 2008
- Total hip arthroplasty for primary septic arthritis of the hip in adultsInternational Orthopaedics, 2007
- Septic Arthritis of the Hip in an Immune Competent Adult: The Significance of the Differential DiagnosisThe Journal of the American Board of Family Medicine, 2007
- Treatment of an infected total hip replacement with the PROSTALAC system. Part 2: Health-related quality of life and function with the PROSTALAC implant in situ.2007
- Cementless Two-Stage Exchange Arthroplasty for Infection after Total Hip ArthroplastyThe Journal of Arthroplasty, 2007
- Use of telephone interviews to follow up patients after total hip replacementJournal of Telemedicine and Telecare, 2005
- Practical Applications of Antibiotic-Loaded Bone Cement for Treatment of Infected Joint ReplacementsClinical Orthopaedics and Related Research, 2004
- The outcome of two-stage arthroplasty using a custom-made interval spacer to treat the infected hipThe Journal of Arthroplasty, 1997