Document Detail


An articulating antibiotic spacer controls infection and improves pain and function in a degenerative septic hip.
MedLine Citation:
PMID:  21519937     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Treating septic arthritis of the hip with coexisting advanced degenerative disease is challenging. The use of primary total hip arthroplasty (THA) has led to postoperative infection rates as high as 22%. Insertion of antibiotic spacers with subsequent reimplantation of a THA controls infection and improves pain and function in patients with periprosthetic infections.
QUESTIONS/PURPOSES: We asked whether two-stage exchange for patients with degenerative joint disease (DJD) and coexisting septic arthritis would control infection and improve pain relief and function both during the period after insertion of the spacer and after conversion to THA.
METHODS: We retrospectively reviewed 14 patients with severe DJD and either active or recent septic arthritis treated with débridement and insertion of a primary antibiotic-loaded cement spacer between 1996 and 2008. Ten patients underwent subsequent exchange to a permanent hip arthroplasty. Four patients did not undergo exchange to a permanent THA: two died from unrelated causes and two elected not to proceed with exchange because their spacer provided adequate function. We obtained a modified Harris hip score. The minimum clinical followup was 7 months (average, 28 months; range, 7-65 months) after insertion of the spacer.
RESULTS: Mean pain scores improved from 6 to 34, and overall Harris hip scores improved from 11 to 67 at last followup with the spacer. Those who underwent definitive THA had further improvement in their mean Harris hip scores to 93.
CONCLUSIONS: Articulating antibiotic spacers offer acceptable pain relief and function while the infection is treated in this unique group of patients.
LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors:
Erin E Fleck; Mark J Spangehl; Venkat R Rapuri; Christopher P Beauchamp
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-09-30     Completed Date:  2011-11-30     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3055-64     Citation Subset:  AIM; IM    
Affiliation:
Department of Orthopaedic Surgery, Mayo Clinic Arizona, 5777 Mayo Boulevard, Phoenix, AZ 85054, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anti-Bacterial Agents / administration & dosage*
Arthritis, Infectious / complications,  physiopathology,  therapy*
Arthroplasty, Replacement, Hip / adverse effects,  instrumentation,  methods*
Bone Cements / therapeutic use*
Disability Evaluation
Female
Gentamicins / administration & dosage
Health Status
Hip Joint / microbiology,  pathology,  physiopathology
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Osteoarthritis, Hip / complications,  physiopathology,  therapy*
Pain / etiology,  physiopathology
Pain Management
Prosthesis-Related Infections / complications,  physiopathology,  therapy*
Reoperation
Retrospective Studies
Tobramycin / administration & dosage
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Bone Cements; 0/Gentamicins; 32986-56-4/Tobramycin
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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