Purpose:

Use of prefabricated mobile spacers in end-stage cases of hip periprosthetic joint infection (HPJI) is hindered when large bone defects exist. In such cases, prefabricated custom-made antibiotic spacers (P-CMAS) offer an alternative. Such spacers are individually designed according to the size and anatomical characteristics of the bone defect. The purpose of this study is to describe and evaluate the use of such patient-specific spacers in a two-stage strategy to treat end-stage HPJI cases, and to report on clinical outcomes.

Methods:

A retrospective study identified all patients with end-stage HPJIs from January 2015 through December 2019, treated using a P-CMAS. Primary outcome: infection eradication rate. Secondary outcomes: spacer-related complications and patient satisfaction. Minimum follow-up: 12 months after the second-stage surgery.

Results:

A total of 7 end-stage cases (mean of 6.7 previous surgical procedures) were included. Mean bone defect size was 191.57 (range 47–304) mm. Polymicrobial infection was detected in 42.86% of these cases. During the spacer stage there were no periprosthetic fractures, spacer dislocations or breakages, nor spacer-drug-related complications. All patients proceeded with the second stage uneventfully, with an average time between stages of 178 (range 119–326) days. In 5 cases a total femur arthroplasty was the reconstructive procedure performed. After a mean follow-up of 27.29 (range 14–49) months the infection was clinically eradicated in all patients, despite their difficult-to-treat scenarios.

Conclusions:

Industrially custom-made spacers offer an effective and safe option in performing 2-stage exchange arthroplasty in cases of end-stage HPJI with extensive bone defects.

中文翻译：

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终末期髋关节假体周围感染的两阶段策略：工业预制定制抗生素垫片的效用

目的：

当存在大的骨缺损时，在髋关节假体周围感染 (HPJI) 的终末期病例中使用预制的活动垫片会受到阻碍。在这种情况下，预制定制抗生素垫片 (P-CMAS) 提供了一种替代方案。这种垫片是根据骨缺损的大小和解剖特征单独设计的。本研究的目的是描述和评估这种患者特异性垫片在治疗终末期 HPJI 病例的两阶段策略中的使用，并报告临床结果。

方法：

一项回顾性研究确定了 2015 年 1 月至 2019 年 12 月期间所有使用 P-CMAS 治疗的终末期 HPJI 患者。主要结果：感染根除率。次要结果：垫片相关并发症和患者满意度。最短随访时间：二期手术后 12 个月。

结果：

共纳入 7 例终末期病例（平均 6.7 例既往手术）。平均骨缺损大小为 191.57（范围 47-304）毫米。这些病例中有 42.86% 检测到多种微生物感染。在垫片阶段，没有发生假体周围骨折、垫片脱位或断裂，也没有与垫片药物相关的并发症。所有患者顺利进入第二阶段，阶段之间的平均时间为 178（范围 119-326）天。在 5 例中，进行了全股骨关节置换术。在平均随访 27.29 个月（范围 14-49）个月后，所有患者的感染均在临床上被根除，尽管这些患者的治疗方案难以治疗。

结论：

在具有广泛骨缺损的终末期 HPJI 的情况下，工业定制的垫片为执行 2 阶段置换关节置换术提供了一种有效且安全的选择。