Periprosthetic joint infection is a significant complication of total hip arthroplasty. The PRSThesis of Antibiotic Loaded Acrylic Cement (PROSTALAC) system can improve health related quality of life during a two step treatment approach for infection resolution. We investigated quality of life with the PROSTALAC in situ and also compared subjects who underwent second stage surgery with those who retained the PROSTALAC on a long term basis.

Twenty nine subjects were enrolled pre-PROSTALAC insertion, recording demographics, physical demand level and comorbidities. Subjects were then followed out to 24 months with either the PROSTALAC in situ or post revision for those who underwent the second stage surgery. Quality of life was evaluated using the Western Ontario McMaster Osteoarthritis Index (WOMAC) and RAND 36-Item Health Survey (RAND-36). Infection resolution was also determined for all subjects enrolled.

Three subjects died and 22/26 (84%) completed the evaluation. Overall 26 (85%) infections resolved. Following PROSTALAC insertion, WOMAC pain and function scores improved within three to six months and did not change out to 24 months. Physical function, bodily pain and vitality also significantly improved within three to six months postoperatively. Only seven (32%) subjects underwent second stage surgery. These individuals were more likely to be high demand (p=0.03) and trended towards being younger, male, with fewer comorbidities and lower BMI (p<0.10). There was no difference in WOMAC scores at 24 months between those who underwent second stage revisions and those who retained the PROSTALAC.

The use of a PROSTALAC implant improves health related quality of life. Long term retention of the PROSTALAC implant may be appropriate for low demand patients and considered for potentially high risk surgical candidates.