Can Reliable Infection Therapy be Accomplished in Two-Stage Revisions Utilizing Antibiotic Spacers?

A recent study showed infection eradication and improved clinical outcomes when an antibiotic spacer was inserted during a two-stage revision for PJI.

 

In the United States, total hip and knee arthroplasties (THA and TKA) are clinically and cost effective procedures for end-stage arthritis.1 With such success, one study predicts that THA will increase by 171% and TKA by 189% by 2030 in the United States. 1

Promising outcomes of THA and TKA have contributed to a decline in overall revision surgeries due to loosening and wear but the occurrence of periprosthetic joint infection (PJI) is still a significant complication after arthroplasty.2 More than 14% of hip revisions in the United States are attributed to these infections and are expected to increase. 3

With PJI being a surgical challenge, numerous studies have been published over the past decade discussing infection prevention and surgical procedures that reduce the occurrence found in patients.

A 2018 study, published by The Journal of Arthroplasty, showed reliable infection eradication and improved clinical function when an articulating antibiotic spacer was inserted during a THA two-stage revision for PJI. 4

Nonarticulating antibiotic spacers have been utilized in the past to deliver antibiotics to the infected area, but patients often experienced limited function during the resection period.4 Articulating antibiotic hip spacers have become more favorable because they offer surgeons and patients the advantage of delivering high-dose antibiotics to the infected area, while providing greater hip mobility than alternative spacers.4 

The recent study conducted by Kevin I. Perry, M.D., Mayo Clinic Orthopedic Surgeon, demonstrated a survivorship of 92% at two years and 88% at five years after reimplantation when utilizing an articulating antibiotic spacer during a two-stage revision.4 The data also presented improvements in Harris Hip Scores from a mean of 58 to 71 points in the spacer phase and a mean of 81 points post-reimplantation. 4

Despite the success, trochanteric deficiency, dislocation of the articulating spacer and female gender were substantial risk factors for post-reimplantation dislocation. 4 To offset these risks, Perry et al. suggests surgeons may want to consider the use of a dual-mobility or constrained articulation in these patients.4

  1. Sloan, M. et al. Projected Volume of Primary and Revision Total Joint Arthroplasty in the United States, 2030-2060. American Academy of Orthopedic Surgeons. New Orleans, LA. 2018.
  2. Springer, B. et al. Infection Burden in Total Hip and Knee Arthroplasties: An International Registry-based Perspective. Arthroplasty Today. 3: 137-140, 2017.
  3. Kapadia, B. et al. Periprosthetic Joint Infection. The Lancet. 387 (10016): 386-394, 2016.
  4. Chalmers, B. et al. Two-stage Revision Total Hip Arthroplasty with a Specific Articulating Antibiotic Spacer Design: Reliable Periprosthetic Joint Infection Eradication and Functional Improvement. The Journal of Arthroplasty. 33: 3476-3753, 2018. 
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