Impact of Antibiotic-Impregnated Spacer Design in the Treatment of Periprosthetic Hip Infection

Eytan M. Debbi, MD, PhD; Zachary A. Rockov, MD; Ian G. Schroeder, MD; Evan D. Nigh, MD; Landon S. Polakof, MD; Sean S. Rajaee, MD, MS; Dheeraj R. Yalamanchili, MD; Guy D. Paiement, MD

Arthroplasty Today (Dec 2022)

Impact of Antibiotic-Impregnated Spacer Design in the Treatment of Periprosthetic Hip Infection

Eytan M. Debbi, MD, PhD,
Zachary A. Rockov, MD,
Ian G. Schroeder, MD,
Evan D. Nigh, MD,
Landon S. Polakof, MD,
Sean S. Rajaee, MD, MS,
Dheeraj R. Yalamanchili, MD,
Guy D. Paiement, MD

Affiliations

Eytan M. Debbi, MD, PhD: Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Zachary A. Rockov, MD: Corresponding author. Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Boulevard, Suite 603, Los Angeles, CA 90048, USA. Tel.: +1 310 423 4566.; Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Ian G. Schroeder, MD: Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Evan D. Nigh, MD: Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Landon S. Polakof, MD: Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Sean S. Rajaee, MD, MS: Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Dheeraj R. Yalamanchili, MD: Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Guy D. Paiement, MD: Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

Journal volume & issue: Vol. 18
pp. 168 – 172

Abstract

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Background: Although 2-stage exchange arthroplasty, consisting of temporary insertion of an antibiotic-impregnated cement spacer (AICS), is considered the standard of care for chronic periprosthetic joint infection (PJI) in total hip arthroplasty (THA), a consensus on the AICS design has not yet been established. Ceramic-on-polyethylene AICSs (Poly-AICS) are theorized to cause less pain and better function than cement-on-bone AICS (CemB-AICS) but use non-antibiotic-impregnated components that may harbor bacteria. This study evaluates the impact of spacer design on infection-free survivorship following THA reimplantation as well as pain and function during the interim AICS stage. Methods: A retrospective review was performed of all cases of THA PJI treated with either Poly-AICS or CemB-AICS at a single high-volume academic center. Data were collected until the final follow-up after THA reimplantation with an average follow-up duration of 2.6 years. The primary outcome was infection-free survivorship after the final reimplantation. Secondary outcomes included postoperative pain scores, opioid use, time to ambulation, length of stay, complications, and discharge disposition. Results: A total of 99 cases (67 CemB-AICS; 32 Poly-AICS) were included. There were no baseline differences between the 2 groups. There were no differences in infection-free survivorship after reimplantation in survivorship curve comparisons (P = .122) and no differences in postoperative inpatient pain scores, opioid use, length of stay, time to ambulation, complications, or discharge disposition during the AICS stage. Conclusions: Patients with THA PJI treated with Poly-AICS did not have worse infection-related outcomes despite the use of non-antibiotic-impregnated components but also did not appear to have less pain or improved function during the early AICS stage.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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