Abstract
Introduction: Septic total hip arthroplasty is a devastating complication. Most treatment protocols for infection of more than 2 – 3 weeks duration recommend removal of the prosthesis and cement followed by 4 – 6 weeks of IV antibiotics. Results using an antibiotic spacer to allow mobility of the patient and local antibiotic deliverance by elution from the spacer are reported.
Methods: Since January of 1994, antibiotic spacers have been used as adjunctive treatment along with IV antibiotics and prosthetic resection in 18 septic total hips. The spacer is fashioned intraoperatively using a femoral Rush Rod as reinforcement. Antibiotics are chosen based upon either a previous hip aspiration result or empirically chosen on intraoperative gram stain results.
Results: Fifteen patients have been reimplanted and are, to date, apparently free of infection. The average time to reimplantation was approximately 8 weeks (range: 4 to 24 weeks). Two patients were unable to be reimplanted due to persistent infection and currently have resection arthroplasties. One patient died prior to reimplantation.
Discussion and conclusions: The use of a spacer has allowed the mobilization of the patient in a manner similar to a total hip arthroplasty while keeping the patient’s leg length approximately the same. Reimplantation is less traumatic for the surgeon as well as the patient and allows for the local deliverance of antibiotics to the tissues similar to the use of antibiotic beads. The authors believe the use of an antibiotic spacer in the treatment of septic total hip has been extremely useful in these difficult cases.
The abstracts were prepared by Nico Verdonschot. Correspondence should be addressed to him at Orthopaedic Research Laboratory, University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
