Purpose: Our purpose was to compare 2 methods of treatment of chronic infection in hip arthroplasties – with or without an antibiotic-loaded cement spacer.

Methods: In a prospective study, we treated 68 infected hip arthroplasties with discharging sinuses and bone loss, comparing 30 patients treated in 2 stages with-out the use of a spacer (control group) and 38 patients treated with a vancomycin-loaded spacer (study group). The average follow-up was 7 years (5–11.5 years). One patient died of unrelated causes 4 months after first-stage surgery and was excluded from the study.

Results: The 2-stage surgery without spacer controlled the infection in 66.7% of patients, and the 2-stage surgery using the spacer controlled it in 89.1% (P < 0.05). At last follow-up, the average Harris Hip Score increased from 19.3 to 69.0 in the control group versus 19.7 to 75.2 in the study group (P > 0.05). The average leg length discrepancy was 2.6 cm in the control group and 1.5 cm in the study group (P < 0.05). The patients treated with a spacer had better clinical results (81.5% of patients with good results against 60.0% for the control group)

Conclusion: The use of an antibiotic-loaded spacer in the 2-stage treatment of infected hip arthroplasties provides better infection control with good functional results and is superior to treatment in 2 stages without a spacer.

Level of Evidence: Therapeutic study, Level I-1.

Two-stage reconstruction is a well-recognized treatment for deep infection of hip joint implants, but there is a lack of objective data to support the use of a spacer between stages. The purpose of the study was to report the results of our treatment using a standardized protocol.

Methods: Sixty-five consecutive patients with deep infection of the hip prosthesis with discharging sinuses and bone loss were treated according to a prospective, two-stage resection/reimplantation protocol with and without the use of a vancomycin-loaded, hand-moulded cement spacer.

Results: Mean hospital lenght of stay was longer in both stages for the patients treated without a spacer. Mean surgical time was 40 minutes longer in the first stage for the spacer group but 60 minutes less at the second stage for the same group. Blood loss and blood transfusions were lower in the spacer group for both stages. Infection was eradicated in 92% of the patients after the first-stage operation in the spacer group and in 69% of the non-spacer group. The mean interval between the first and second stages was 11.4 weeks. 33 patients treated with a spacer had the second stage surgery and only two (6%) became infected again. Of the 17 patients of the non-spacer group than had reimpantation, 5 (29%) had recurrence of infection. Allografts were used in 53% of the patients of the non-spacer group and in 65% of the spacer group. The mean duration of follow-up was 42 months (range 24–84 months). The mean Harris hip score at follow-up improved from 19,3 to 69 in the non-spacer group and from 19,7 to 75,2 in the spacer group. Mean limb-lenght discrepancy was higher for the non-spacer group (26,cm comparing to 1,5cm). At the end of the study, 84% of patients treated with a spacer had good results comparing to only 35% of patients treated without a spacer.

Conclusion: We have found that our two-stage treatment protocol with the use of a spacer is a more reliable approach for the management of infected hip prostheses than a two stage approach without the use of a spacer.