AbstractBackground: orthopaedic surgeons still struggle against a devastating complication – periprosthetic joint infection (PJI). A two-stage revision is
considered the gold standard for chronic PJI for several authors, with
success rates over 90 %. This strategy implies the remotion of the
prosthesis and the implantation of an antibiotic-impregnated cement spacer
in the joint. The primary objective of this study was to assess the
effectiveness of a two-stage revision approach using a commercial
prefabricated antibiotic-impregnated cement hip spacer for the treatment of
hip PJI regarding monomicrobial and polymicrobial infections. Secondly, to
assess risk factors for failure of two-stage revision.Material and methods:
we conducted a retrospective study on patients that underwent revision of
total hip arthroplasty (THA) between January 2002 and January 20218. We included adult patients with a diagnosis of chronic hip PJI that underwent two-stage revision using a
prefabricated gentamicin-impregnated cement of polymethylmethacrylate (PMMA)
hip spacer. We assessed whether it was monomicrobial or polymicrobial infections and comorbidities. Treatment success was defined when eradication of the
infection was observed and no further procedures or mortality were
registered after the second stage. Persistence or recurrence of infection
was considered a failure of treatment.Results: the final series consisted
of 84 patients treated with the same hip spacer: 60 (71.4 %) monomicrobial
and 24 (28.6 %) polymicrobial joint infections with an overall follow-up
of 59.0 (36.0–84.0) months. The overall success rate was 90.5 %. Eight
(9.5 %) patients failed. Smoking and BMI greater than 30 m kg-2were
identified independent risk factors for failure in multivariate analysis.Conclusion: our study suggests that prefabricated gentamicin-impregnated
PMMA spacer is an effective tool for the treatment of PJI, achieving similar
outcomes whether it is monomicrobial or polymicrobial infections. Randomized prospective studies are needed to obtain more reliable conclusions.