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Archives of Orthopaedic and Trauma Surgery

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11.09.2024 | Hip Arthroplasty

The role of acetabular cement augmentation in 2-stage revision arthroplasty for prosthetic joint infection of the hip

verfasst von: Francesco Raspanti, Luigi Zanna, Rudy Sangaletti, Matteo Innocenti, Francesco Benazzo, Roberto Civinini, Marco Mugnaini

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 12/2024

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Abstract

Introduction

In the treatment of chronic prosthetic joint infection (PJI) of the hip, two-stage exchange arthroplasty is commonly employed. Various spacer designs, including Hemi-Spacers and Articulating Spacers, are utilized during this process. However, these spacers are associated with a high rate of mechanical complications and pose a risk of progressive bone loss. This study aims to compare these two types of spacers in terms of mechanical complications, center of rotation (COR) restoration, and preservation of acetabular bone stock.

Materials and methods

From 2019 to 2022, patients who underwent two-stage exchange arthroplasty for hip PJI across three hospitals were retrospectively reviewed. Data including demographic, clinical, and microbiological information were collected. Radiographic imaging was analyzed to measure acetabular bone erosion, COR, and periacetabular bone resected. Additionally, the average surgical time in the first and second stages, mechanical complications, and the mean duration of the inter-stage period were recorded.

Results

Forty patients were divided into two groups: Group A (Articulating Spacer, n = 23) received a preformed femur spacer with acetabular cement augmentation, while Group B (Hemi-Spacer, n = 17) received a preformed femur spacer alone. Acetabular cement augmentation slightly prolonged the first stage but facilitated a faster second stage during subsequent reimplantation. Spacer dislocation rates were 8.7% in Group A and 17.6% in Group B during the interstage period. Radiographic analysis revealed a statistically significant greater degree of acetabular erosion in Group B. A significant difference in Vertical-COR differential was observed, with a more proximalized revision cup compared to the primary cup in Group B, and Horizontal-COR values closer to the native hip in Group A.

Conclusions

Dynamic spacers with acetabular cement augmentation help preserve peri-acetabular bone stock and prevent progression of acetabular bone erosion during the inter-stage period. Additionally, these spacers reduce the dislocation rates, making reimplantation easier and leading to better restoration of hip biomechanics during the second procedure.

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Titel: The role of acetabular cement augmentation in 2-stage revision arthroplasty for prosthetic joint infection of the hip
verfasst von: Francesco Raspanti
Luigi Zanna
Rudy Sangaletti
Matteo Innocenti
Francesco Benazzo
Roberto Civinini
Marco Mugnaini
Publikationsdatum: 11.09.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 12/2024
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-024-05541-w

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The role of acetabular cement augmentation in 2-stage revision arthroplasty for prosthetic joint infection of the hip