Clinical application of augmented antibiotic-loaded cement spacer in two-stage infected total hip arthroplasty with acetabular bone defect / 中华骨科杂志

ABSTRACT

Objective To investigate the clinical outcomes and complications of augmented antibiotic-loaded cement spacer in two-stage infected total hip arthroplasty with acetabular bone defect.Methods The periprosthetic infection (PJI) patients with acetabular bone defect were retrospectively reviewed from January 2007 to June 2016 in our hospital.A total of 26 patients (11 males and 15 females) were eligibly included in the present study.The mean age was 46.7 years old.The two-stage revision arthroplasty included implants removel,meticulous debridement,implantation of antibiotic-loaded cement spacer in firststage.After systemic therapy of antibiotics,the prosthesis was implanted in the second-stage.The supra-acetabular antibiotic cement shelf with screws was used to improve hip stability with acetabular wall defect.The handmade acetabular spacer was able to prevent femoral spacer ifto pelvis in patients with acetabular internal wall defect.The clinical outcomes and complications (spacer dislocation,spacer fracture and acetabular wear) were measured.Results The positive rate of bacteria culture was 80.8％ (21/26)and 57.7％ (15/26) patients were cultured with staphylococcus.The others were 2 fungus,2 Gram-positive rod,1 brucella,1 pseudomonas aeruginosa,1 escherichia coli,1 enterococcus faecalis,1 defective probiotics,1 serratiamarcescens and 1 Kocuriaroseus.Moreover,19.2％ (5/26) patients were mixed infection.There was one patient with spacer dislocation and two with spacer fracture.No patients were recurrent infection.Infection was controlled,and two-stage revision was successfully performed in 24 patients.Twenty-two patients were followed averaging 4.1 years (1-8) and the Harris Hip Score was significantly improved from 40.9± 14.0to 81.2± 11.2 at the final follow-up (P＜0.05).Conclusion The application of augmented antibiotic-loaded cement spacer has satisfactory clinical outcomes in PJI patients with acetabular bone defect.It can provide joint mobility and increase additional joint stability with decreased iatrogenic bone defect caused by acetabular wear.