Periprosthetic joint infection is a serious problem and requires great effort and cost for its treatment. The issues related to this situation are duration of antibiotic, stages of surgery and time of reimplantation of prosthesis. The surgical solution may vary from Antibiotic suppression, Irrigation and Debridement, Head and Liner exchange, One stage exchange, two stage exchange and Resection Arthroplasty. Two stage revision remains the gold standard for the treatment of periprosthetic joint infection after THA. It has seen infection free survival rates of 80-100%. We aim to find the efficacy and cost effectiveness of handmade antibiotic impregnated articulating cement spacer over commercially available prefabricated hip spacer for the treatment of deep periprosthetic joint infection.
Material and methods: A total of 23 patients were enrolled in this prospective cohort study. In the two stages of revision, the first stage surgery comprised of removal of infected prosthesis and bone cement, thorough debridement of all infected and necrotic tissue and implantation of handmade articulating antibiotic impregnated cement hip spacer. Antibiotics were given for 6 weeks after first stage surgery based on culture sensitivity. Antibiotics were stopped two weeks prior to second stage to foresee the patient’s response. Routine aspiration of the involved joint was done prior to 2nd stage. The decision to proceed with prosthesis implantation was determined by clinical evaluation, resolution of blood markers (ESR and CRP) and a negative hip joint aspirate. The second stage surgery consisted of removal of cement spacer and implantation of new prosthesis. Patients were evaluated for rate of infection control and hip joint function.
Results: The two stage revision total hip arthroplasty with handmade articulating antibiotic impregnated cement spacer was done in 23 patients. The mean age of the patients was 57+_7 years, with 15 male and 8 females. All patients had deep chronic periprosthetic joint infection with increased ESR and CRP level. Coagulase negative staphylococci were the most common pathogen followed by Staphylococcus aureus. The mean time between the two stages is 16-20weeks.All hip cultures were found to be negative before second stage. Three patients had persistent joint infection following the first stage of surgery. In one patient the infection was cured by additional debridement and repeated first stage surgery. In two patents, infection was not cured, Resection Arthroplasty was done. 19 patients were free of infection at an average follow up of 24months. Infection free survival was 82.60% at the end of 2 years. HHS was 82 (Range) at 2 years follow up.
Conclusion: After evaluation of our 23 patients we conclude that two stage revision by hand made cement spacer for treatment of infected arthroplasty is an effective means of treating infected THR. Our handmade antibiotic impregnated cement spacer is safe and cost effective and provides effective local antibiotic delivery.