R Erivan1, T Lecointe2, G Villatte3, A Mulliez4, S Descamps3, S Boisgard3. 1. CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Service de chirurgie orthopédique, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France. Electronic address: rerivan@chu-clermontferrand.fr. 2. Service de chirurgie orthopédique, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France. 3. CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Service de chirurgie orthopédique, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France. 4. Délégation à la recherche clinique et aux innovations (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
Abstract
INTRODUCTION: The aim of the present study was to assess our management of infected total hip replacement in indications for 2-stage surgical treatment according to current guidelines when a cement spacer has been used. The study hypothesis was that the complications rate related to cement spacers is low. MATERIAL AND METHOD: A single-center retrospective study included 26 patients receiving a spacer between the two stages of total hip replacement, over a 5 year period. We analyzed the spacers used, mechanical complications, infectious complications and the second stage of surgery. RESULTS: During the interval between surgeries, in the 26 patients, there were 19 spacer-related mechanical complications (73% of patients): 11 dislocations (42.3%), 5 spacer fractures (19.2%), 5 femoral bone lyses or fractures (19.2%) and 3 acetabular lyses or fractures (11.5%). In 4 cases, complications were associated. The greater the femoral offset of the spacer, the more frequent were femoral bone lyses or fractures (p=0.05), and the smaller the offset the more frequent were acetabular lyses or fractures (p=0.05). The rates of mechanical complications (p=0.003) and spacer fracture (p=0.02) were significantly greater in older patients. There were 4 cases of reinfection (19%): i.e., an 81% treatment success rate. One reinfection implicated a new bacterium: methicillin-susceptible Staphylococcus aureus. The second surgical stage was significantly longer in complex bipolar revision (p=0.009). CONCLUSION: The present results showed a high risk of spacer-related complications, and thus the importance of selection of patients liable to derive real benefit and those for whom a Gilderstone procedure would be preferable. LEVEL OF EVIDENCE: IV, retrospective study.
INTRODUCTION: The aim of the present study was to assess our management of infected total hip replacement in indications for 2-stage surgical treatment according to current guidelines when a cement spacer has been used. The study hypothesis was that the complications rate related to cement spacers is low. MATERIAL AND METHOD: A single-center retrospective study included 26 patients receiving a spacer between the two stages of total hip replacement, over a 5 year period. We analyzed the spacers used, mechanical complications, infectious complications and the second stage of surgery. RESULTS: During the interval between surgeries, in the 26 patients, there were 19 spacer-related mechanical complications (73% of patients): 11 dislocations (42.3%), 5 spacer fractures (19.2%), 5 femoral bone lyses or fractures (19.2%) and 3 acetabular lyses or fractures (11.5%). In 4 cases, complications were associated. The greater the femoral offset of the spacer, the more frequent were femoral bone lyses or fractures (p=0.05), and the smaller the offset the more frequent were acetabular lyses or fractures (p=0.05). The rates of mechanical complications (p=0.003) and spacer fracture (p=0.02) were significantly greater in older patients. There were 4 cases of reinfection (19%): i.e., an 81% treatment success rate. One reinfection implicated a new bacterium: methicillin-susceptible Staphylococcus aureus. The second surgical stage was significantly longer in complex bipolar revision (p=0.009). CONCLUSION: The present results showed a high risk of spacer-related complications, and thus the importance of selection of patients liable to derive real benefit and those for whom a Gilderstone procedure would be preferable. LEVEL OF EVIDENCE: IV, retrospective study.