Antibiotic-loaded Medullary-sparing Cemented Articulating Spacer for the Treatment of Advanced Pyogenic Arthritis in Adult Hip: A Retrospective Study
Background: Advanced pyogenic arthritis of the hip is not a rare and emergent disease but can cause local damage and even systemic morbidity. Various techniques for preparing antibiotic-loaded spacers have been reported. A novel spacer, designed as a medullary-sparing method, has been introduced and...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2024-07-01
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| Series: | Formosan Journal of Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/fjmd.FJMD-D-23-00008 |
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| Summary: | Background:
Advanced pyogenic arthritis of the hip is not a rare and emergent disease but can cause local damage and even systemic morbidity. Various techniques for preparing antibiotic-loaded spacers have been reported. A novel spacer, designed as a medullary-sparing method, has been introduced and tested with a limited number of patients. The spacer shows promise in effectively treating infections while preserving femoral integrity.
Objectives:
This article presents a case series analysis to assess the outcomes of medullary-sparing cemented spacers in septic hip arthritis.
Materials and Methods:
This is a retrospective study conducted between January 2019 and December 2020. All patients underwent two-stage revision with antibiotic cement spacers for interim. Cancellous screws were inserted into the cross section and parallel to the long axis of the femoral neck after the removal of femoral head. Then, antibiotic-loaded bone cement was hand-molded into adequate shape and size. Positive outcomes observed with reduced mechanical complications, reoperation rates, and improved functional scores.
Results:
A total of 27 male and 9 female patients are included in this cohort study at least 2-year follow-up. Surgical outcomes included 16.7% spacer mechanical complications (joint dislocation, revised in three cases). The radiologic findings revealed satisfactory anatomic restoration, with a mean femoral offset discrepancy of 6.1 ± 3.4 mm and a lower limb length discrepancy of 9.1 ± 7.8 mm. Functional outcomes showed significant Modified Harris Hip Score improvement (35.6–59.4) and activity scores (3.9–5.2) throughout treatment process (P < 0.01). A promising approach involves total hip arthroplasty (THA) conversion and bone grafting for select cases with acetabular defects.
Conclusions:
In this retrospective study with substantial case number, medullary-sparing cemented articulating spacers demonstrated effectiveness and reliability in septic arthritis treatment. This approach successfully controls infection and enables subsequent THA. Moreover, it restores anatomical alignment and significantly improves functional outcomes. This combined achievement highlights the promising potential of the medullary-sparing cemented articulating spacers in the treatment of septic arthritis of the hip joint. |
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| ISSN: | 2210-7940 2210-7959 |