TY - JOUR
T1 - Two-Stage Revision Total Hip Arthroplasty With a Specific Articulating Antibiotic Spacer Design
T2 - Reliable Periprosthetic Joint Infection Eradication and Functional Improvement
AU - Chalmers, Brian P.
AU - Mabry, Tad M.
AU - Abdel, Matthew P.
AU - Berry, Daniel J.
AU - Hanssen, Arlen D.
AU - Perry, Kevin I.
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/12
Y1 - 2018/12
N2 - Background: Two-stage revision utilizing spacers loaded with high-dose antibiotic cement prior to reimplantation remains the gold standard for treatment of periprosthetic joint infections (PJI) in total hip arthroplasty (THA) in North America, but there is a paucity of data on mid-term outcomes. We sought to analyze the survivorship free of infection, clinical outcomes, and complications of a specific articulating spacer utilized during 2-stage revision. Methods: One hundred thirty-five hips (131 patients) undergoing a 2-stage revision THA for PJI with a specific articulating antibiotic spacer design from 2005 to 2013 were retrospectively reviewed. Infections were classified according to the Musculoskeletal Infection Society criteria. Mean age at resection was 65 years and mean follow-up was 5 years (rang, 2-10). Results: Survivorship free of any infection after reimplantation was 92% and 88% at 2 and 5 years, respectively. Patients with a host-extremity grade of C3 compared to all patients with a host grade of A [hazard ratio (HR) 4.1, P =.05] were significant risk factors for poorer infection-free survivorship after reimplantation. Harris hip scores improved from a mean of 58 to a mean of 71 in the spacer phase (P =.002) and a mean of 81 post-reimplantation (P =.001). Fourteen (10%) patients dislocated after reimplantation, 9 (7%) of which required re-revision. Trochanteric deficiency (HR 19, P <.0001), dislocation of the articulating spacer prior to reimplantation [which occurred in 7 (5%) patients, 5 of whom subsequently dislocated the definitive implant] (HR 16, P <.0001), and female gender (HR 5, P =.002) were significant risk factors for post-reimplantation dislocation. Conclusion: Insertion of an articulating antibiotic spacer during a 2-stage revision THA for PJI demonstrates reliable infection eradication and improvement in clinical function, including the spacer phase. Patients with trochanteric deficiency and an articulating spacer dislocation are at high risk of post-reimplantation dislocation; judicial use of a dual-mobility or constrained device should be considered in these patients.
AB - Background: Two-stage revision utilizing spacers loaded with high-dose antibiotic cement prior to reimplantation remains the gold standard for treatment of periprosthetic joint infections (PJI) in total hip arthroplasty (THA) in North America, but there is a paucity of data on mid-term outcomes. We sought to analyze the survivorship free of infection, clinical outcomes, and complications of a specific articulating spacer utilized during 2-stage revision. Methods: One hundred thirty-five hips (131 patients) undergoing a 2-stage revision THA for PJI with a specific articulating antibiotic spacer design from 2005 to 2013 were retrospectively reviewed. Infections were classified according to the Musculoskeletal Infection Society criteria. Mean age at resection was 65 years and mean follow-up was 5 years (rang, 2-10). Results: Survivorship free of any infection after reimplantation was 92% and 88% at 2 and 5 years, respectively. Patients with a host-extremity grade of C3 compared to all patients with a host grade of A [hazard ratio (HR) 4.1, P =.05] were significant risk factors for poorer infection-free survivorship after reimplantation. Harris hip scores improved from a mean of 58 to a mean of 71 in the spacer phase (P =.002) and a mean of 81 post-reimplantation (P =.001). Fourteen (10%) patients dislocated after reimplantation, 9 (7%) of which required re-revision. Trochanteric deficiency (HR 19, P <.0001), dislocation of the articulating spacer prior to reimplantation [which occurred in 7 (5%) patients, 5 of whom subsequently dislocated the definitive implant] (HR 16, P <.0001), and female gender (HR 5, P =.002) were significant risk factors for post-reimplantation dislocation. Conclusion: Insertion of an articulating antibiotic spacer during a 2-stage revision THA for PJI demonstrates reliable infection eradication and improvement in clinical function, including the spacer phase. Patients with trochanteric deficiency and an articulating spacer dislocation are at high risk of post-reimplantation dislocation; judicial use of a dual-mobility or constrained device should be considered in these patients.
KW - complications
KW - periprosthetic joint infection
KW - revision
KW - total hip arthroplasty
KW - two-stage
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U2 - 10.1016/j.arth.2018.08.016
DO - 10.1016/j.arth.2018.08.016
M3 - Article
C2 - 30236495
AN - SCOPUS:85053340048
SN - 0883-5403
VL - 33
SP - 3746
EP - 3753
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 12
ER -