CANNULATED ARTICULATING SPACER IN THE TREATMENT OF TOTAL HIP ARTHROPLASTY INFECTION

Abstract

The weak points and complications of the classic spacers are eliminated by the construction of an articulated spacer. We did have very good results with the application of a classic spacer and considered the negative properties of the articulated spacer as a foreign matter in the wound. Gradually, the excellent literary results, standardization of the procedure, faster rehabilitation and a significant growth of comfort for the patient convinced us of the fact, that we chose the right way. Therefore we prepared and verified the new implant. In its construction we used the experience from the creation of classic spacers as well as the principle of a drained spacer allowing a drainage of the cavity of the femur. The implant is constructed as a module to be enwrapped by as large amount of the bone cement with an antibiotics as possible. The cup is flat with a diameter of 42 mm, with grooves allowing adhesion of as large a quantity of cement as possible with the articular area for the head of a diameter of 28 mm. For a better stability of the implant, it is constructed as antiluxation one. The implant stem consists of three parts so that a high modularity is secured upon low costs. The body of the stem has a single length and it is furnished in the axis with a drain enabling the use of a flush lavage. For a better modularity, it is possible to fit on the stem body three different lengths of the neck. In 2002 and 2004, the articulated spacer was used to treat 26 patients with a deep infection of a hip joint prosthesis. The treatment of the infection has been successful in all cases. The period of leaving the drained articulated spacer was 12,8 weeks. The result of the Harris hip score when after implantation it reaches on average 94.7 points. The contribution of this method is also supported by an even more average growth of the Harris hip score as opposed to the condition prior to operation, which was 37,5 points. The patients did not feel any pain in between the operations. The only restriction of the quality of life was brought by a recommended necessity of walking with crutches. The technique combines the advantages of a two-stage procedure with flexibility of the reimplanting term and the economic and social profits for the patient.