Complications with cement spacers in 2-stage treatment of periprosthetic joint infection on total hip replacement
Résumé
Introduction
The aim of the present study was to assess our management of infected total hip replacement in indications for 2-stage surgical treatment according to current guidelines when a cement spacer has been used. The study hypothesis was that the complications rate related to cement spacers is low.
Material and method
A single-center retrospective study included 26 patients receiving a spacer between the two stages of total hip replacement, over a 5 year period. We analyzed the spacers used, mechanical complications, infectious complications and the second stage of surgery.
Results
During the interval between surgeries, in the 26 patients, there were 19 spacer-related mechanical complications (73% of patients): 11 dislocations (42.3%), 5 spacer fractures (19.2%), 5 femoral bone lyses or fractures (19.2%) and 3 acetabular lyses or fractures (11.5%). In 4 cases, complications were associated. The greater the femoral offset of the spacer, the more frequent were femoral bone lyses or fractures (p = 0.05), and the smaller the offset the more frequent were acetabular lyses or fractures (p = 0.05). The rates of mechanical complications (p = 0.003) and spacer fracture (p = 0.02) were significantly greater in older patients. There were 4 cases of reinfection (19%): i.e., an 81% treatment success rate. One reinfection implicated a new bacterium: methicillin-susceptible Staphylococcus aureus. The second surgical stage was significantly longer in complex bipolar revision (p = 0.009).
Conclusion
The present results showed a high risk of spacer-related complications, and thus the importance of selection of patients liable to derive real benefit and those for whom a Gilderstone procedure would be preferable.