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.
Aim. Identification of the causal pathogen is crucial in the management of periprosthetic joint infection (PJI) of the hip. Unfortunately, it was often difficult and negative culture could be a common findings. This situation made the treatment of PJI of the hip became more challenging. The negative culture finding resulted in a doubtful diagnosis of infection, and poses difficulty in choosing the appropriate antibiotics. Here we compared the treatment outcome of
INTRO.
The Control of Infection Committee at a specialist orthopaedic hospital prospectively collected data on all episodes of bacteriologically-proven deep infection arising after primary hip and knee replacements over a 15-year period from 1987 to 2001. There were 10 735 patients who underwent primary hip or knee replacement. In 34 of 5947 hip replacements (0.57%) and 41 of 4788 knee replacements (0.86%) a deep infection developed. The most common infecting micro-organism was coagulase-negative staphylococcus, followed by Of the infections, 29% (22) arose in the first three months following surgery, 35% between three months and one year (26), and 36% (27) after one year. Most cases were detected early and treated aggressively, with eradication of the infection in 96% (72). There was no significant change in the infection rate or type of infecting micro-organism over the course of this study. These results set a benchmark, and importantly emphasise that only 64% of peri-prosthetic infections arise within one year of surgery. These results also illustrate the advantages of conducting joint replacement surgery in the isolation of a specialist hospital.