All patients' records that have been treated by hip spacer implantation in our institution between 01.01.1999 and 30.06.2008 have been retrospectively evaluated regarding following parameters: primary surgical indication, causative pathogen organism, time between infection manifestation and spacer implantation, duration of spacer implantation, spacer articulation, impregnation of bone cement, systemic antibiotics, and implant type at reimplantation. Moreover, mechanical complications (spacer dislocation, spacer fracture, femoral fracture, prosthesis dislocation after reimplantation) and systemic side effects (renal and hepatic failure, respectively, allergic reactions, ototoxicity) as well as general postoperative complications were also documented. Only patients with a sufficient documentation regarding all above mentioned parameters were included in the study.
Femoral fractures occurred in 12 cases (13.6 %). 5 out of these 12 cases occurred at the first stage and were treated by implantation of an antibiotic-coated femoral nail and spacer implantation on top. Four cases with a femoral scissure, respectively, were managed by minimal weight-bearing of the particular extremity. One case suffering from an avulsion of the minor trochanter was treated by cerclage refixation. After prosthesis reimplantation, one patient suffered from a periprosthetic fracture which was treated with a plate osteosynthesis. One patient had a fracture beneath the spacer stem and was treated by implantation of an antibiotic-coated prosthesis stem and placement of a spacer head onto the stem.
19. Magnan B, Regis D, Biscaglia R, Bartolozzi P. Preformed acrylic bone cement spacer loaded with antibiotics. Use of two-stage procedure in 10 patients because of infected hips after total replacement. 2001;72:591-4
36. Wentworth SJ, Masri BA, Duncan CP, Southworth CB. Hip prosthesis of antibiotic-loaded acrylic cement for the treatment of infections following total hip arthroplasty. 2003;84(Suppl 2):123-8
12. Hsieh PH, Shih CH, Chang YH, Lee MD, Shih HN, Yang WE. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. 2004;86:1989-1997
The overall complication rate was 58.5 % (48/82 cases). A spacer dislocation occurred in 15 cases (17 %). Spacer fractures could be noticed in 9 cases (10.2 %). Femoral fractures occurred in 12 cases (13.6 %). After prosthesis reimplantation, 16 patients suffered from a prosthesis dislocation (23 %). 2 patients (2.4 %) showed allergic reactions against the intravenous antibiotic therapy. An acute renal failure occurred in 5 cases (6 %). No cases of hepatic failure or ototoxicity could be observed in our collective. General complications (consisting mostly of draining sinus, pneumonia, cardiopulmonary decompensation, lower urinary tract infections) occurred in 38 patients (46.3 %).
Antibiotic-loaded cement spacers are an efficient method in the treatment of hip joint infections. However, during treatment several complications might occur that might endanger the infection eradication as well as the functional outcome after prosthesis reimplantation. Our data demonstrate that > 50 % of patients suffering from hip joint infections and treated with a two-stage protocol will have some kind of complications besides reinfection or infection persistence, mostly consisting of mechanical ones (spacer fracture, -dislocation, femoral fracture, prosthesis dislocations), systemic side effects (acute renal failure, allergic reactions), and general complications (draining sinus, pneumonia, etc.). Despite the retrospective design of our study and the limited possibility of interpreting these findings and their causes, this rate indicates that these patients are prone to have some kind of complication. Orthopedic surgeons should be aware of these complications and their treatment options and concentrate on the early diagnosis for prevention of further complications. Between stages, an interdisciplinary cooperation with other facilities (internal medicine, microbiologists) should be aimed for patients with several comorbidities for optimizing their general medical condition.
9. Duncan CP, Beauchamp C. A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip. 1993;24:751-9
It is a rapidly changing interdisciplinary domain, in which each branch of engineering interacts with a number of other disciplines to yield a fundamental understanding of health maintenance processes and improved diagnosis, optimal interventional (surgical, therapeutic & rehabilitative) procedures, prosthesis and organ assist systems, health care systems performance and econometrics.
Osmania University is the first University to start Biomedical Engineering at undergraduate level in the country.
The design includes a 15 degree anti-dislocation rim and an anti-impingement recess, intended to increase the range of motion of the articulation. Intended for use with the SHP hip stem. The socket comes in 22.22, 26 and 28mm internal diameters. Arcom ® is Biomet’s conventional proprietary compression moulded UHMWPE, and is sterilized by gamma irradiation in an inert, argon environment. The cup was first used in 1994 and has a 5A ODEP rating. A study by Nivbrant et al (1) showed increased migration of the SHP socket and stem compared with the Lubinus SP2, measured by RSA.
Reference: Nivbrant, Bo , Kärrholm, Johan and Söderlund, Per(1999) 'Increased migration of the SHP prosthesis: Radiostereometric comparison with the Lubinus SP2 design in 40 cases', Acta Orthopaedica, 70: 6, 569 — 577