This article is more than 5 years old. Information may no longer be current.
Two-stage hip revision with antibiotic-loaded spacer shows high success rate
Of 11 patients who had a re-infection, seven were infection-free following a repeat procedure.
A long-term follow-up investigation shows that two-stage revision with an interval antibiotic-loaded hip spacer may be highly successful in treating infection after total hip arthroplasty, and can provide function comparable to that achieved in non-infected revision cases.
Timothy Kostamo, MD, and colleagues studied the 10- to 15-year outcomes of nearly 100 patients who underwent two-stage revision with an interim, antibiotic-loaded prosthesis for hip infection. Final follow-up for 93% of the group revealed that 11 out of 103 patients had a re-infection. Of these, seven patients underwent a repeat procedure and were subsequently infection-free.
The investigators categorized four patients as having treatment failures. Two patients required a resection, one had a hip disarticulation and another developed a chronic infection that was treated with suppressive antibiotics. In addition, three patients required revision for aseptic loosening, two for recurrent dislocation and one for hardware removal.
The investigators also compared the quality-of-life data for 71% of the remaining patients with that of non-infected patients who underwent hip revision.
They found no significant differences between the groups regarding SF-12, Oxford-12 and global WOMAC scores. While the non-infected group had higher activity scores, both groups showed high levels of patient satisfaction.
|
|
|
|
The investigators used these metal molds to prepare the implant to be coated with an antibiotic-laden cement. Images: Kostamo T |
|
“Safe and effective”
“Two-stage revision with an interim antibiotic-loaded, temporary prosthesis is a safe and effective means to treat an infected hip arthroplasty,” Kostamo said during his presentation at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. “The long-term success rate out to 10 to 15 years and beyond is 89%. An added exchange for our recalcitrant cases brings us up to 96%. Function and satisfaction are high.”
Kostamo noted that earlier study results showed a high infection cure rate. at the 2- to 3-year mark.
The study included 99 patients who had an interval antibiotic-loaded hip spacer as part of a two-stage revision. To assess the long-term outcomes, the investigators administered the SF-12, Oxford-12 and WOMAC questionnaires to the living patients and contacted the relatives of the deceased patients to determine the patient’s functional status, and whether the patient had a recurrent infection or underwent a revision.
|
|
Lost to follow-up
Forty-eight patients were living, 44 had died without evidence of infection and seven were lost to final follow-up.
“Limitations for this study include a 7% loss to follow-up,” Kostamo said. “If these are all presumed failures, our success rate would drop to 84%. We only had a limited radiographic follow-up available due to the very scattered nature of our patient population.”
|
|
|
|
These X-rays show the interim antibiotic-loaded spacer (left) in the femur with a cemented snap-fit acetabulum and the final cementless reconstruction (right). |
|
For more information:
- Timothy Kostamo, MD, can be reached at the University of British Columbia, Department of Orthopedics, Room 3415, 910 W. 10th Avenue, 3rd Floor, Vancouver, BC V5Z 4E3, Canada; 604-875-4646; e-mail: tkostamo@hotmail.com. He has no direct financial interest in any products or companies mentioned in this article.
Reference:
- Kostamo T, Biring GS, Masri BA, et al. Two-stage hip revision for infection: A 10-15 year follow-up in 103 patients. Paper #349. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.