Cannulated spacer in the treatment of deep infection of total hip arthroplasty using a two-stage reimplantation
Abstract
Objective. Eradication of infection through insertion of a solid antibiotic-loaded PMMA spacer during the first stage of a two-stage reimplantation for deep infection to prevent shortening, to obtain a high local concentration of antibiotics in and to permit lavage of the medullary canal.
Indications. Deep infection after total hip arthroplasty (THA) in patients who are candidates for revision surgery, especially in instances where the infection is confined to the region of femoral component.
Contraindications. Large defect of proximal femur.
Poor general health not allowing two procedures. Surgical Technique.
Extraction of both components, removal of all necrotic material and cement. Intraoperative manual modeling of a cannulated spacer using bone cement premixed with antibiotics, its shape resembling a Moore's prosthesis.
The spacer is shaped around a size 16 drain into which a corresponding Kirschner wire is inserted. Once the spacer is completely set, the Kirschner wire is removed and the drain shortened.
A size 8 lavage drain tube is then inserted into the spacer and the hip reduced. Results.
We used the spacer in the treatment of 29 patients with infected THA. The interval between spacer implantation and insertion of the total hip implants was 11.6 weeks.
Re-infection after implantation of the spacer was observed twice necessitating a second debridement, implantation of a new spacer, and lavage. Success rate of two-stage revision was 96.5%.
The Harris hip score reached an average of 90.1 points. Breakage of the spacer was observed twice, and dislocation occurred in five patients; both did not affect the final result.