Management of Periprosthetic Joint Infection After Total Hip Arthroplasty Using a Custom Made Articulating Spacer (CUMARS); the Exeter Experience
Section snippets
Methods
All patients were treated at a single centre by experienced arthroplasty surgeons. All patients suspected of a periprosthetic hip infection on clinical and radiological grounds were investigated with serum C-reactive protein (CRP) assay and erythrocyte sedimentation rate (ESR). Infection was considered to be present if the CRP was greater than 10 mg/L and/or the ESR was greater than 30 mm/h [14] in combination with clinical suspicion. Pre-operative aspiration for cell count, gram stain, culture
Results
Between January 2001 and August 2010, 76 hips in 75 patients underwent treatment for hip infection using a CUMARS construct at the first stage. There were 38 females and 37 males in the study with ages ranging from 37 to 93 years (mean 71.5, SD 10.7). The reasons for revision are listed in Table 1.
Of these 76 cases, 42 (55.3%) continued to the second stage (two of which had repeated first stage, as described below) at a median 20.4 weeks (IQR 17.6 weeks, range 28 days–2.7 years) between stages (
Discussion
The management of PJI is often time-consuming and associated with costly use of hospital and surgeon resources 19., 20.. Treatment ranges from long-term antibiotic suppression, debridement with prosthetic retention, resection arthroplasty, to one- or two-stage re-implantation or arthrodesis. In terms of patient satisfaction and long-term functional outcomes, eradication of infection and re-implantation are desirable 21., 22.. Contemporary literature remains divided as to the best method for
Acknowledgments
The authors would like to thank Mr Graham Gie, Mr John Timperley and Mr Matthew Hubble for their invaluable continuing contribution to the evolution of this technique.
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Cited by (54)
Articulating Spacers in Total Hip Arthroplasty: Surgical Technique and Outcomes
2024, Orthopedic Clinics of North AmericaImpact of Antibiotic-Impregnated Spacer Design in the Treatment of Periprosthetic Hip Infection
2022, Arthroplasty TodayArticulated bipolar vs. non-articulated conventional spacers: A comparative study of results from two-stage treatment of chronic septic arthritis in prosthetic or native hips
2022, Revue de Chirurgie Orthopedique et TraumatologiqueArticulated bipolar vs. non-articulated conventional spacers: A comparative study of results from two-stage treatment of chronic septic arthritis in prosthetic or native hips
2022, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :In the case of a two-stage procedure, either a unipolar or a bipolar spacer can be used while awaiting reimplantation, but these spacers have numerous mechanical complications [12,13,23–35]. Various authors [29–35] confirm the stability difficulties encountered with the unipolar spacer. Leunig et al. [29] demonstrated that the instability is significantly higher in cases of an offset loss favored by the unipolar spacer (p < 0.05).
The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.04.013.