In the JournalsPerspective

Antibiotic spacers in THA yields infection eradication, improved clinical function

Data published in The Journal of Arthroplasty showed infection eradication and improved clinical function when an articulating antibiotic spacer was inserted during a two-stage revision total hip arthroplasty for periprosthetic joint infection.

Kevin I. Perry, MD, orthopedic surgeon at Mayo Clinic and assistant professor of orthopedics at Mayo Clinic College of Medicine and Science, and colleagues identified 135 hips in 131 patients undergoing a two-stage revision total hip arthroplasty for periprosthetic joint infection with Prostalac acetabular and femoral components (DePuy) and classified infections according to Musculoskeletal Infection Society criteria.

Results showed patients had a survivorship free of any infection after reimplantation of 92% at 2 years and 88% at 5 years postoperatively. Researchers noted a significant risk factor for poorer infection-free survivorship after reimplantation included patients with a host-extremity grade of C3 compared with all patients with a host grade of A. Researchers also found improvements in Harris Hip Scores from a mean of 58 points to a mean of 71 points in the spacer phase and to a mean of 81 points post-reimplantation. After reimplantation, 10% of patients experienced dislocation, of whom 7% required re-revision, according to results. Significant risk factors for post-reimplantation dislocation included trochanteric deficiency, dislocation of the articulating spacer prior to reimplantation and female sex, according to researchers.

“Insertion of an articulating antibiotic spacer during a two-stage revision THA for [periprosthetic joint infection] PJI demonstrates reliable infection eradication and improvement in clinical function, including during the spacer phase,” Perry told Healio.com/Orthopedics. “Nevertheless, patients with trochanteric deficiency or spacer dislocation are at high risk of post-reimplantation dislocation.” – by Casey Tingle

Disclosures: Perry reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

Data published in The Journal of Arthroplasty showed infection eradication and improved clinical function when an articulating antibiotic spacer was inserted during a two-stage revision total hip arthroplasty for periprosthetic joint infection.

Kevin I. Perry, MD, orthopedic surgeon at Mayo Clinic and assistant professor of orthopedics at Mayo Clinic College of Medicine and Science, and colleagues identified 135 hips in 131 patients undergoing a two-stage revision total hip arthroplasty for periprosthetic joint infection with Prostalac acetabular and femoral components (DePuy) and classified infections according to Musculoskeletal Infection Society criteria.

Results showed patients had a survivorship free of any infection after reimplantation of 92% at 2 years and 88% at 5 years postoperatively. Researchers noted a significant risk factor for poorer infection-free survivorship after reimplantation included patients with a host-extremity grade of C3 compared with all patients with a host grade of A. Researchers also found improvements in Harris Hip Scores from a mean of 58 points to a mean of 71 points in the spacer phase and to a mean of 81 points post-reimplantation. After reimplantation, 10% of patients experienced dislocation, of whom 7% required re-revision, according to results. Significant risk factors for post-reimplantation dislocation included trochanteric deficiency, dislocation of the articulating spacer prior to reimplantation and female sex, according to researchers.

“Insertion of an articulating antibiotic spacer during a two-stage revision THA for [periprosthetic joint infection] PJI demonstrates reliable infection eradication and improvement in clinical function, including during the spacer phase,” Perry told Healio.com/Orthopedics. “Nevertheless, patients with trochanteric deficiency or spacer dislocation are at high risk of post-reimplantation dislocation.” – by Casey Tingle

Disclosures: Perry reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

    Perspective

    Chalmers and colleagues present a review of outcomes in 131 revision THA treated for PJI with a two-stage exchange using a specific articulating antibiotic spacer design. At 5-year follow-up, survivorship free of any infection after reimplantation was 88%. Furthermore, Harris Hip Scores significantly improved both in the spacer phase and post-reimplantation. There was a 16% rate of perioperative orthopedic complications, including 10% dislocation and 9% intraoperative fracture, as well as a 23% reoperation rate at 5-years. The authors conclude that insertion of an articular spacer during two-stage revision can provide reliable PJI eradication and improvement in clinical function, including during the spacer phase.

    While these data support the gold standard practice of two-stage exchange for chronic PJI eradication in North America and highlight the functional advantages with use of an articulating spacer, there are certain caveats to consider. First, as noted by the authors, this method may not be suitable in patients with complex acetabular deformity or pelvic discontinuity, proximal femoral bone loss and severe soft tissue compromise where immobilization is critical. Second, the methodology presented may present added difficulty at the time of spacer removal. Third, the use of these articulating components may pose an added financial burden in the present era of healthcare cost scrutiny. Lastly, the issue of patient attrition between first and second stage has not been specifically considered. Nonetheless, this study provides very encouraging data pertaining to infection eradication, complications, and functional outcomes with the use of an articulating hip spacer for PJI.

    • Karan Goswami, MD
    • Fellow, Rothman Institute at Thomas Jefferson University Hospital
      Philadelphia, Pa.

    Disclosures: Goswami reports no relevant financial disclosures.