a simple insertion, a partial/full cementation, the “glove”-technique, and, a cement bridge in case of large osseous defects of the proximal femur. To our knowledge, it is still unknown which of these methods provides the best stability. Between 01.01.1999–31.12.2008, 84 hip spacer implantations in 78 patients have been performed in our department. All patients have been treated with the same kind of spacer. 24 spacers have been fixed with the “glove”-technique, 18 with a partial cementation onto the proximal femur, 21 with a simple insertion, and 4 with a cement bridge. In 17 cases with an isolated septic loosening of the acetabular cup, only a spacer head has been placed onto the well-fixed prosthesis stem. The overall dislocation rate between stages was 21.4 % (18/84). The lowest dislocation rate was observed in the “spacer head” group with 5.8 % (1/17), followed by the “glove”-technique with 12.5 % of the cases (3/24). In the “partial cementation” group the dislocation rate was 22.2 % (4/18), whereas in the “insertion” group spacer dislocations occurred in 9 out of 21 cases (42.8 %). In the latter group, in 3 cases the spacer rotated primarily in the femur and dislocated subsequently out from the acetabulum. From the 4 patients having been treated with a cement bridge, 2 patients suffered from a spacer dislocation. From these 18 cases, 15 patients have been treated conservatively by reduction and immobilization in a hip orthesis during the remaining time between stages. The other three cases underwent further surgical procedures; in one case (combined spacer dislocation and -fracture), the spacer had been exchanged, whereas the other two cases had been treated by resection arthroplasty after recurrent spacer dislocations and unsuccessful conservative treatment. The “glove”-technique seems to be the most effective method for femoral fixation fixation of hip spacers regarding the prevention of dislocations between stages. Further advantages of this technique include a safe and easy spacer explantation in one piece without cement debris at the second stage.
The patient group treated with an intra-articular glucocorticoid injection series also showed significant improvements for the Constant and Murley Score (p<
.0001), the Simple Shoulder Test (p<
.0001) and the visual analog scales for pain, function and patient satisfaction (p<
.0001) after 4 weeks and also at any other follow up. Significant improvements were also seen in abduction (p<
.0001), flexion (p<
.0001) and external rotation (p=.001) and internal rotation (p=.035) after 4 weeks of treatment. These results were confirmed at any other follow up. Comparison of the two treatment regimen showed superior short term results for the intra-articular treatment regimen in range of motion, Constant Score and Simple Shoulder Test and patient satisfaction (p<
.05). No significant differences were found in the visual analog scales for pain and function (p>
.05).
Implantation of antibiotic-loaded beads is accepted as an efficient option for local antibiotic therapy in orthopedic-related infections. However, recent reports have emphasized the bacteria growth persistence on antibiotic-impregnated bone cement. Hence, the aim of this study was to elaborate if bacterial adherence and growth could be determined on explanted gentamicin- and gentamicin-vancomycin-loaded beads after infection eradication. 18 chains of antibiotic-loaded beads (11 gentamicin-, 7 gentamicin-vancomycin-loaded) were examined. Indications for primary beads implantation included postoperative infections after total hip or knee arthroplasty, rotator cuff reconstruction, chronic foot osteomyelitis, anterior cruciate ligament reconstruction and dorsal spondylodesis. Among the isolated organisms, Staphylococcus epidermidis, Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) were the most frequent ones. In 4 cases (3 × S. epidermidis, 1 × MRSA) bacteria growth persistence could be determined on the beads. S. epidermidis-strains persisted only on gentamicin-loaded beads, MRSA could grow on gentamicin-vancomycin-impregnated cement. In one case, the emergence of a gentamicin-resistant S. epidermidis-strain could be observed despite preoperative susceptibility. Bacteria growth persistence on bone cement is a hazardous problem in the orthopedic surgery and should therefore be born in mind. Adherence to cement can lead to emergence of bacteria resistance despite preoperative antibiotic susceptibility and might result in clinical recurrence of infection.