Treatment of Infected Hip Arthroplasty with Antibiotic-Loaded Cement Spacers.
10.5371/jkhs.2009.21.2.148
- Author:
Yoon Je CHO
1
;
Kang Il KIM
;
Young Soo CHUN
;
Kee Hyung RHYU
;
Joon Ha ROH
;
Young Jun KIM
;
Myung Chul YOO
Author Information
1. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea. yjcho@khmc.or.kr
- Publication Type:Original Article
- Keywords:
Infected THA;
Two-stage revision THA;
Antibiotic-loaded cement spacers
- MeSH:
Arthroplasty;
Biopsy;
Blood Cell Count;
C-Reactive Protein;
Erythrocyte Count;
Follow-Up Studies;
Gallium;
Head;
Hip;
Humans;
Joints
- From:Journal of the Korean Hip Society
2009;21(2):148-155
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: This study evaluated the effect of antibiotic-loaded cement spacers on the treatment of infected hip arthroplasty. MATERIALS AND METHODS: Twenty-one patients, twenty-one cases that experienced infection after total hip arthroplasty, were treated with two-stage arthroplasty using antibiotic-loaded cement spacers between July 1995 and March 2005. The average age was 56.3 years (range, 36~84 years). The follow-up period was 7.2 years (range, 3~11.4 years). The period from the first operation to diagnosis of infection was 28 months (range, 1~49 months). Preoperative culture, Tc 99m scan or Gallium scan, intraoperative culture and biopsy were performed for the evaluation of infection. We postoperatively evaluated clinical and radiological outcomes, blood analysis including serologic study, complete blood cell count, differential count, erythrocyte sedimentation rate and C-reactive protein. RESULTS: Of a total of 21cases, acetabular cup, femoral head and femoral stem were substituted in 10 cases (48%). Acetabular cup and femoral head were substituted in 11 cases (52%). Revision arthroplasty was performed in 19 cases, on average 11.9 months (range 2~31 months) after insertion of antibiotic-loaded cement spacers. Infection recurred in 1 case. In 18 cases, excluding the reinfected one, the average Harris hip score, 46.8 points (range, 35~72 points) preoperatively, improved to 89.5 points (range, 78~100 points) at last follow-up in the revision group. In 2 cases in which revision total hip arthroplasty was not performed, the Harris hip score was 53 points (range, 36~70 points) preoperatively, and 86 points (range,72~100 points) at last follow-up. CONCLUSION: The use of antibiotic-loaded cement spacers in two-stage arthroplasty is an effective method for management of infection, preserving joint function until performing revision arthroplasty. Preservation of the femoral stem should be considered in cases in which were fixed firmly and in cases which show no evidence of the spreading of infection to the distal part of the stem on Tc 99m scan or Gallium scan performed preoperatively.
