Two-stage revision in periprosthetic joint infection of the hip using a new intraoperatively molded articulating spacer design

Giorgio Cacciola; Fortunato Giustra; Francesco Bosco; Federico De Meo; Antongiulio Bruschetta; Pietro Cavaliere

doi:10.1016/j.jcot.2023.102223

Two-stage revision in periprosthetic joint infection of the hip using a new intraoperatively molded articulating spacer design

J Clin Orthop Trauma. 2023 Jul 16:43:102223. doi: 10.1016/j.jcot.2023.102223. eCollection 2023 Aug.

Authors

Giorgio Cacciola¹, Fortunato Giustra^{1

2}, Francesco Bosco^{1

2}, Federico De Meo³, Antongiulio Bruschetta³, Pietro Cavaliere³

Affiliations

¹ University of Turin, Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, Via Gianfranco Zuretti, 29, 10126, Turin, Italy.
² Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino, ASL Città di Torino, Turin, Italy.
³ Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy.

PMID: 37520268
PMCID: PMC10372186 (available on 2024-07-16)
DOI: 10.1016/j.jcot.2023.102223

Abstract

Purpose: The treatment of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is still under debate. Two-stage exchange arthroplasty is the most common surgical procedure performed. This study analyzed a new functional articulating hip spacer called "Spaceflex" regarding the mechanical-related complications, the recurrent/persistent infection during the interval period, the overall infection-free survivorship after reimplantation, the overall complication/reoperation after reimplantation and the evaluation of patient-reported outcome measures (PROMs) at three intervals of time: before the first stage, during the interval period, and at the final follow-up after reimplantation.

Methods: A consecutive series of 56 patients with chronic hip PJI undergoing two-stage prosthetic revision using a new intraoperatively molded articulating hip spacer design implanted by the same experienced surgeons was examined from January 2017 to December 2021. The demographic and clinical characteristics of the included patients were analyzed. Specifically, PROMs before the first stage, during the interval period, and at the final follow-up after reimplantation and complications reported during the interval period and after reimplantation were examined.

Results: The new functional articulating hip spacer was characterized by a low mechanical complication rate (5.8%) and an overall two-stage procedure success rate of 90.6% at the last follow-up. PROMs improved with the spacer during the interval period and at the final follow-up. Furthermore, the reinfection rate was in line with other case series with different spacer designs. Finally, low postoperative complication rates after reimplantation have been demonstrated.

Conclusions: Two-stage revision performed with a modular articulating spacer allows patients to preserve satisfactory functional and quality-of-life outcomes in the postoperative period, with a low risk of mechanical complications and without increasing the reinfection rate.

Keywords: Periprosthetic joint infection, PJI; Total hip arthroplasty, THA; Two-stage.