Two-Stage Revision Total Hip Arthroplasty With a Specific Articulating Antibiotic Spacer Design: Reliable Periprosthetic Joint Infection Eradication and Functional Improvement

Brian P. Chalmers, Tad M. Mabry, Matthew Abdel, Daniel J. Berry, Arlen D. Hanssen, Kevin I. Perry

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)3746-3753
Number of pages8
JournalJournal of Arthroplasty
Volume33
Issue number12
DOIs
StatePublished - Dec 1 2018

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Replantation
Arthroplasty
Hip
Joints
Anti-Bacterial Agents
Infection
Survival Rate
North America
Extremities
Equipment and Supplies

Keywords

  • complications
  • periprosthetic joint infection
  • revision
  • total hip arthroplasty
  • two-stage

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Two-Stage Revision Total Hip Arthroplasty With a Specific Articulating Antibiotic Spacer Design : Reliable Periprosthetic Joint Infection Eradication and Functional Improvement. / Chalmers, Brian P.; Mabry, Tad M.; Abdel, Matthew; Berry, Daniel J.; Hanssen, Arlen D.; Perry, Kevin I.

In: Journal of Arthroplasty, Vol. 33, No. 12, 01.12.2018, p. 3746-3753.

Research output: Contribution to journalArticle

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title = "Two-Stage Revision Total Hip Arthroplasty With a Specific Articulating Antibiotic Spacer Design: Reliable Periprosthetic Joint Infection Eradication and Functional Improvement",
abstract = "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.",
keywords = "complications, periprosthetic joint infection, revision, total hip arthroplasty, two-stage",
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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

AU - Berry, Daniel J.

AU - Hanssen, Arlen D.

AU - Perry, Kevin I.

PY - 2018/12/1

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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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