A Study On Self-made,Antibiotic-loaded Cement Articulating Spacers In The Treatment Of The Infected Hip Replacement

ObjectiveTo study the mechanical complications and efficacy of self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement.MethodsBetween January 2006 and July 2016, 265 patients (266 hips) received a self-made,antibiotic-loaded cement articulating spacer as part of a two-stage protocol. Among the patients, there were 143 males (144 hips) and 122 females(122 hips). The cement articulating spacers with vancomycin and two Steinmann pins were made by a self-made mold system. Meanwhile, another antibiotics were added to the spacers according to the drug sensitivity test. The overall frequency of complications (spacer fracture, dislocation) was recorded. Clinical and radiographic follow-up was regularly performed by Harris hip score system and X-ray. Evaluations were made for the efficiency of infection control.Results:The mean age at the time of the first stage of two-stage revision operation was 57.4±14.2 years. 39 patients (14.7%) used extended trochanteric osteotomy (ETO) to remove the infected hip replacement. Overall, 38 of 265 patients suffered one of the above-mentioned complications (14.3%). Spacer fracture occurred in 28 cases (10.5%)and dislocation in 10 cases(3.8%). All the patients were followed up for an average period of 83.4 ± 14.6 months. The Harris hip score was 47.16 ± 13.29 preoperatively and 73.82 ± 11.67 after the first-stage surgery(P<0.05). In the 256 patients (257 hips)underwent procedure of the second stage revisions, the Harris hip score was 47.56 ±14.23 before the first-stage surgery and 86.43 ± 12.84 at last follow-up after the second stage revisions(P<0.05). Average interval between the first and second stage operation was 4.2 ± 1.3 months (range, 3-13months). The infection control rate was 96.6% after the first-stage surgery and 95.1% at last follow-up because of 4 cases of recurrence of infection after the second stage revisions.Conclusions:Antibiotic-loaded cement articulating spacer made by a self-made mold system is an effective method for the two-stage revision of the infected hip replacement. Our data revealed an complication rate of 14.3 % with a mould spacer enclosing two Steinman pins. Using of metallic internal fixation or allograft bone combined with spacer does not affect the results of infection controlling.