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.

Introduction: This study addresses the long term results of 1225 uncomplicated primary total knee arthroplasties performed between 1986 and 1995, using one design with various tibial fixation methods.

Methods: 1225 primary total knees were performed using a press fit total condylar cruciate retaining design. 108 cases were eliminated because of death and 171 due to lack of follow up leaving a group of 946 knees. Mean time insitu is 9.2 years. 500 knees had both the tray and stem cemented, 374 had only the tray cemented, and 72 used no cement. Both clinical and radiographic Knee Society Scores were tabulated preoperatively and annually thereafter. The SF-36 has been recorded both pre and postoperatively since 1993.

Results: Overall revision rates for the cemented, tray only and non-cemented groups were 1.0%, 3.4% and 12.5%, respectively. A combined 20 cases had the tibial component revised due to polywear and osteolysis with 0.6% from the cemented group, 2.4% from the tray only group and 11.1% from the tray only group. The joint portion of the Knee Society score was comparable for the cemented and tray only groups (88.9 and 88.3, respectively) but only 80.9 for the non-cemented group.

Discussion and conclusion: Using a component design that meets the needs of the majority of patients regardless of bone quality has proven to be successful and cost effective for this institution. The authors believe these excellent results and low revision rate for loosening indicate this design has much to offer with its flexibility of tibial fixation.