TREATMENT OF INFECTED TOTAL HIP ARTHROPLASTY WITH PROSTALAC ARTICULATING SPACER – TECHNICAL TIPS AND ADVENTAGES

Abstract

We evaluated the effects on infection control and clinical feasibility of a prosthesis with antibiotic-loaded acrylic cement(PROSTALAC) which was designed for treatment of infected total hip arthroplasty.

Thirty patients underwent two-staged exchange arthroplasty using the PROSTALAC for treatment of the infected total hip arthroplasty were analysed from March 1995 to February 2007. For shaping of the stem spacer, cement containing antibiotics were appropriately coated on stem spacer and push and pull movement was carried out within the medullary cavity of proximal femur until cement hardened. Also, for prevent of post surgical dislocation, a specially designed polyethylene liner was used. Postoperatively, antibiotics were administered for at least 6 weeks according to the results of erythrocyte sedimentation rate and C-reactive protein assessment.

Infection cure rated 83.3% (20 cases) and C-reactive protein normalized in an average of 5.6weeks (2wks~26wks) but ESR showed very variable score. Partial weight bearing with crutch was possible after 2 weeks postoperatively and lower-limb shortening averaged to 1.43 cm (0.5~3) with a mean bending range of 63.6 degrees (40~90). There were neither dislocations nor fractures during patient mobilization and 5 cases, especially in old age showed satisfactory results even without second staged revision. Recurred infection after PROSTALAC insertion occurred in 5 cases (15%).

Appropriate techniques of PROSTALAC insertion for stability allows us to adjust the reimplantation timing to the course of infection control.