Introduction: Infection is a challenging problem in orthopaedic surgery. In oncologic and revision surgery large prosthesis are placed during long procedures, even in patients with immunocompromised status. Infection rates here are reported up to 10%. Infections may necessitate large segmental resections thereby creating large defects. This defect can be filled with antibiotics loaded beads that release the substances locally to sterilise the defect. In recent years solid antibiotic loaded bone cement spacers have been applied. These spacers fill the defect, stabilize the extremity, release antibiotics and keep the soft tissues on their original length. Additionally, the patients will be able to preserve mobile function as well. In small defects prefabricated bone cement spacers temporarily replace the infected hip or knee prosthesis. For larger segmental of terminal defects there are no readily available constructs.

Purpose: To report short term outcome of a newly developed customized spacer concept for treatment of large segmental resections after prosthetic infection or osteomyelitis.

Material and Methods: We have treated 13 patients with large segmental defects after infection treatment with customized antibiotic bone cement spacers reinforced with strong intra-medullar implants like the Gammanail, the DFN and the UHN.

Results: These customized spacers are easy to make, fill the defect, stabilize the extremity, release antibiotics, keep the length of the soft tissues and allow patients to practice and preserve joint function as well. In 11 of 13 patients operated with an interim construct like this, a successful reimplantation of a tumor prosthesis was performed.

Conclusion: With customized antibiotic bone cement spacers augmented with a solid implant one can fill the defect, stabilize the extremity, release antibiotics and keep the soft tissues on their original length and keep function as well in infected tumorprosthesis. Successful reimplantation could be performed in 11 of 13 cases.

Objective of the study is to determine to what extent patients experience more limitations 1–5 years after revision total hip arthroplasty (THA) compared to patients after primary THA, and if this is accompanied by a reduction in physical activity behavior. Five hundred and six patients were included: 372 primary and 134 revision THA. Questionnaires were used to measure limitations and physical activity. Linear regression analysis showed that patients after revision surgery report significantly more, clinically relevant limitations compared with primary THA patients, but did not show a significant difference in mean total minutes of physical activity per week. Physical activity behavior appeared to be similar for primary and revision THA patients. The results stress the importance of determining different aspects of recovery after THA.

Introduction: Despite growing awareness of the beneficial effects of physical activity on health, little is known about the amount of physical activity after THA. Although the WOMAC does not give direct information about the amount of physical activity it can be hypothesized that when patients experience limitations this will have an adverse effect on the amount of physical activity they are involved in. In this way the WOMAC can be predictive for the amount of physical activity. The aim of this study is to determine the correlation between the WOMAC and the amount of physical activity and to determine the predictive value of the WOMAC on meeting the (inter-) national guidelines of health -enhancing physical activity.

Materials and Methods: 364 patients with a THA (minimal one year postoperative) were included. Self-reported physical functioning was assessed by means of the WOMAC and the amount of physical activity by means of the SQUASH. Correlations between the WOMAC and SQUASH-scores were assessed using Pearson’s correlation coefficient. Binary logistic regression modelling was used to determine to which extent the score on the WOMAC was predictive in meeting the (inter-)national guidelines.

Results: A significant, low correlation between the WOMAC and SQUASH-scores (range 0.14 – 0.24) was found. Although the WOMAC was a significant predictor to meet the (inter-) national guidelines of physical activity (p< 0.001), the odds-ratio was low (1.022, 95%CI 1.0121.033). The Nagelkerke R2 was 0.069, implicating that 6.9% of the variance could be explained.

Conclusion: The WOMAC is not suitable to predict the amount of physical activity after THA, necessitating the use of additional quantitative outcome measures.