Abstract
Objective
Two-stage exchange with implantation of a temporary spacer is the gold standard treatment for chronic periprosthetic joint infection of the hip. This article describes a simple and safe technique for handmade spacers at the hip.
Indication
Periprosthetic joint infection of the hip. Septic arthritis of the native joint.
Contraindications
Known allergy against components of polymethylmethacrylate bone cements. Inadequate compliance for two-stage exchange. Patient unfit to undergo two-stage exchange. Bony defect situation at the acetabulum impeding stable reduction of the spacer. Bone loss at the femur jeopardizing stable fixation of the stem. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy.
Surgical technique
Tailoring bone cement with antibiotics. Preparation of a metal endoskeleton. Molding of spacer stem and head by hand. Customizing spacer off-sets to bony anatomy and soft tissue tension. Implantation assuring rotational stability at the femur with a bone cement collar. Confirmation of correct position by intraoperative radiography.
Postoperative management
Restricted weight-bearing. Range of motion as possible. Reimplantation after successful treatment of infection.
Zusammenfassung
Hintergrund
Der zweizeitige Prothesenwechsel mit vorübergehender Implantation eines Spacers ist der Goldstandard zur Behandlung der chronischen periprothetischen Hüftgelenkinfektion. Der Beitrag beschreibt eine einfache und sichere Technik zur Implantation handgeformter Spacer.
Indikation
Infektion einer Hüftgelenkprothese. Septische Arthritis des natürlichen Hüftgelenks.
Kontraindikationen
Bekannte Allergie gegen Inhaltstoffe von Polymethylmethacrylat-Knochenzement. Mangelnde Compliance für einen zweizeitigen Wechsel. Patient zu stark erkrankt, um einen zweizeitigen Wechsel zu überstehen. Knöcherne Defektsituation am Acetabulum, die eine stabile Reposition des Spacers verhindert. Knochendefekt am proximalen Femur, der eine stabile Fixierung des Spacers gefährdet. Weichteilschädigungen, die eine vorübergehende VAC („vacuum assisted wound closure“)-Therapie erfordern.
Operative Technik
Antibiogrammgerechte Antibiotikazugabe zum Knochenzement. Erstellen eines metallernen Endoskeletts für den Spacer. Händisches Formen von Spacer-Kopf und -Schaft. Anpassung des Spacer-Offsets an die knöchernen Bedingungen und die Weichteilspannung. Rotationsstabile Fixierung im Femur mittels Spacer-Kragen aus Knochenzement. Kontrolle der korrekten Positionierung mit intraoperativem Röntgen.
Nachbehandlung
Teilbelastung. Schmerzadaptierte freie Beweglichkeit. Reimplantation einer neuen Prothese bei Infektfreiheit.
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S. von Hertzberg-Bölch, M. Luedemann, J. Oberfeld, A. Jakuscheit and M. Rudert declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.
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Dieter C. Wirtz, Bonn
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Rüdiger Himmelhan, Mannheim
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von Hertzberg-Bölch, S., Luedemann, M., Oberfeld, J. et al. Handmade spacers for two-stage exchange at the hip. Oper Orthop Traumatol 35, 146–153 (2023). https://doi.org/10.1007/s00064-023-00811-z
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DOI: https://doi.org/10.1007/s00064-023-00811-z
Keywords
- Periprosthetic joint infection of the hip
- Two-stage revision arthroplasty
- Reoperation
- Polymethylmethacrylate bone cements
- Admixed antibiotics
- Revision hip