Abstract
Joint replacement is a highly effective intervention to treat osteoarthritis of the hip, relieving pain and improving mobility and quality of life.(1) Periprosthetic joint infection (PJI) is a devastating complication after arthroplasty. Debridement, antibiotics and implant retention are treatment of first choice in case of early infection after total hip arthroplasty (THA).(2) In case of persisting infection, one- or two-stage revision needs to be performed.(3) The use of different kinds of spacers has been widely debated in the past years.(4)
The aim of this study was to determine which type of spacer should be used during the interval of two-stage revision of an infected THA.
A search term with Boolean operators was constructed. We extracted all information regarding study and patient characteristics and baseline clinical and laboratory findings. Data regarding type of spacer and antibiotics used, timing of second stage surgery, tissue culture results, postoperative regimen, functional outcome and patient satisfaction were extracted.
A total of twenty-six studies met our inclusion criteria and were included for data analysis. Ten studies described various preformed spacers, six studies described functional spacers and eleven studies described custom made spacers. See Table 1 for results.
Research should focus on finding the preferred type of treatment and type of spacer to combine a high success rate of infection treatment with a good functional and patient reported outcome. There is a need for a prospective study evaluating patient satisfaction and functional outcome after two-stage revision THA comparing various spacers. Secondly, research should focus on the optimal timing of the second stage procedure.
Functional spacers achieve a comparable rate of infection eradication in the treatment of periprosthetic hip joint infections as compared to preformed spacers. There is insufficient evidence concerning rehabilitation and functional outcome after two-stage revisionTHA to advocate or discourage the use of either kind of interval spacer.
