Use of 1.5-stage Functional Articulating Hip Spacers for Two-stage Treatment of Hip Infection

Boyong Wang; Mingzhang Li; Jin Wang; Pei Han; Qiaojie Wang; Hao Shen

doi:10.1016/j.arth.2024.05.014

Use of 1.5-stage Functional Articulating Hip Spacers for Two-stage Treatment of Hip Infection

J Arthroplasty. 2024 May 10:S0883-5403(24)00447-9. doi: 10.1016/j.arth.2024.05.014. Online ahead of print.

Authors

Boyong Wang¹, Mingzhang Li¹, Jin Wang¹, Pei Han¹, Qiaojie Wang¹, Hao Shen²

Affiliations

¹ Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233,China.
² Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233,China. Electronic address: shenhao7212@sina.com.

PMID: 38735548
DOI: 10.1016/j.arth.2024.05.014

Abstract

Background: A two-stage treatment is commonly used for chronic hip infections. This study compared the clinical efficacy and complications associated with 1.5-stage functional articulating hip spacers (FAHS) and handmade spacers utilized during two-stage treatment.

Methods: This retrospective study included 50 patients who had hip infections, of which 41 were periprosthetic joint infections, 3 were internal fixation infections, and 6 had septic arthritis. They were divided into two groups according to the spacer type: 23 patients treated with handmade spacers comprising 1 to 2 Kirschner wires as an endoskeleton (group A) and 27 patients treated with 1.5-stage FAHS comprising a cemented femoral stem, metal femoral head, and polyethylene acetabular liner or cemented acetabular cup (group B). Clinical characteristics, surgical data, infection control rate, spacer complications, modified Harris hip, visual analog scale, and 36-item Short-Form (SF-36) physical functioning scale scores were compared between the groups. All patients were followed up for at least 24 months after the last surgical procedure.

Results: No significant differences were noted in the infection eradication rate between the two groups (100 versus 96.30%, P = 1.0). The incidence of mechanical complications, especially spacer fracture, was significantly lower in group B than in group A (P = 0.044). Hip function and quality of life were significantly better in group B during the interim period. Group B patients had a longer interval time (median 7.40 versus 4.30 months, P = 0.004) and a lower reimplantation rate than group A patients (42.31 versus 82.61%, P = 0.004).

Conclusion: The 1.5-stage FAHS surgical technique is feasible for the treatment of hip infection, with a lower mechanical complication rate, better hip function, and better quality of life during the interim period compared to that of handmade spacers. The 1.5-stage FAHS with maintained function could delay or negate the need for second-stage revision.

Keywords: 1.5-stage functional articulating hip spacer; handmade spacer; hip infection; two-stage treatment.