Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2020; 11(12): 595-605
Published online Dec 18, 2020. doi: 10.5312/wjo.v11.i12.595
Improved patient reported outcomes with functional articulating spacers in two-stage revision of the infected hip
Ewout S Veltman, Dirk Jan F Moojen, Rudolf W Poolman
Ewout S Veltman, Department of Orthopaedic and Trauma Surgery, OLVG, Amsterdam 1091AC, Netherlands
Dirk Jan F Moojen, Orthopaedic and Trauma Surgery, OLVG, Amsterdam 1091AC, Netherlands
Rudolf W Poolman, Department of Orthopaedic Surgery and Joint Research, OLVG, Amsterdam 1091AC, Netherlands
Author contributions: Veltman ES, Moojen DJF and Poolman RW were responsible for the design of the study and drafting and/or revising the manuscript. Data selection and statistical analysis were performed by Veltman ES.
Institutional review board statement: This study was approved by the local medical ethics committee with reference number 15.080.
Conflict-of-interest statement: The authors have no conflict of interest to mention.
Data sharing statement: No additional data are available.
STROBE statement: The STROBE statement was adhered to while constructing the study and writing the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ewout S Veltman, MD, Doctor, Department of Orthopaedic and Trauma Surgery, OLVG, Oosterpark 9, Amsterdam 1091AC, Netherlands. wout.veltman@gmail.com
Received: April 11, 2020
Peer-review started: April 11, 2020
First decision: September 24, 2020
Revised: October 9, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 18, 2020
Processing time: 246 Days and 21.8 Hours
ARTICLE HIGHLIGHTS
Research background

Infection is a tremendous complication of atheroplasty surgery. In case of chronic infection, a two-stage revision procedure is indicated. For the interval period, several types of antibiotic-loaded spacers are available. Prefabricated spacers have a high complication rate, with instability as its main problem. In recent years, we have implemented the use of a functional articulating antibiotic loaded interval spacer.

Research motivation

The current literature lacks reports on the efficacy and safety of different types of spacers used in two-stage revision of an infected total hip arthroplasty. Physicians are still performing two-stage revision with an interval Girdlestone situation or with a prefabricated spacer, even though the patients' mobility is severely compromised and prefabricated spacers are known to have a high dislocation rate.

Research objectives

This study aims to compare the efficacy and safety of the functional articulating spacer to the previously used prefabricated spacer. We compared the groups on infection eradication rate, complications and functional and patient reported outcome.

Research methods

We retrospectively reviewed all patients treated with two-stage revision of an infected total hip arthroplasty between 2003 and 2016.

Research results

We treated 55 patient with a prefabricated spacer and 15 patients with a functional articulating spacer. The patient reported outcomes for the hip osteoarthritis outcome score and EQ-5D-3L were significantly better for the functional articulating spacer group (both P < 0.01). The infection eradication rate was comparable between the groups (93% and 78%, P > 0.05). The risk of dislocation was comparable, but the number of dislocations was significantly higher for the prefabricated spacer group (P < 0.05).

Research conclusions

Functional articulating spacers lead to comparable infection eradication rate, improved patient reported outcome and less complications compared to prefabricated spacers used for two-stage revision of the infected hip.

Research perspectives

Future studies should evaluate whether our findings can be affirmed in a prospective study with a larger number of patients. Also, it should be evaluated whether it is safe to have a patient retain the spacer when he is satisfied with its function.