To conserve surgical time, we simultaneously fabricated the cement-tapered stem on the back table. Our specialized stem mold was used to produce the antibiotic femoral stem by coating a modular stem (S-ROM, Depuy, Warsw). The femoral head spacer was fabricated by covering a 22 mm CoCr head with a cement-molded spacer (fabricated from a surgical irrigation bulb syringe). Our protocol includes 80 grams (two packs) of polymethylmethacrylate cement (Simplex P; Stryker, Mahwah, NJ), premixed with 1 gram of tobramycin per 40 grams of cement. To this we added 4.8 grams of tobramycin powder, and 2 grams of vancomycin powder for a total of 4.4 grams of antibiotics per 40 grams of cement powder. For mixing we added a third bottle of monomer due to the added volume of the antibiotics. The cement was mixed and poured into the appropriate size tapered stem mold and bulb syringe mold (Fig. , ). A femoral modular stemwas placed into the cement mold (Fig. ), and a femoral head was placed into the syringe mold (Fig. ). After full polymerization of the cement, the mold and bulb syringe were split and the stem and head were removed (Fig. , ). The stem was placed appropriately into the femoral canal (Fig. ). The hip was reduced and stability examined. After verification of desired anteversion angle the spacer was secured by adding cement into the medial calcar flare and coating the exposed body of the implant to provide adequate rotational stability. The added cement protocol included 40 grams (one pack) of polymethylmethacrylate cement (Palacos R+G; Zimmer, Warsaw, IN), premixed with 0.5 gram of gentamycin per 40 grams of cement. To this we added 2.4 grams of tobramycin powder, and 1 gram of vancomycin powder for a total of 3.9 grams of antibiotics per 40 grams of cement powder. The decision to use two different cements for each phase of the surgery is due to their different work time, Simplex is more liquid and easier to pour into the mold, and Palacos has more work time and easier to use for “free hand” molding.
Hence, the aim of the present retrospective study was to register and define complications after hip spacer implantation and prosthesis reimplantation, respectively, in the treatment of late hip joint infections. Specific attention was paid to the aforementioned mechanical complications, systemic side effects as well as general complications.
"Prostalac Hip Temporary Prosthesis ", pp
Because no other reference group was available, in situ WOMAC and SF-36 scores were compared with the population data of patients with osteoarthritis before and after uncomplicated THR surgery (See , ). Our referent group comprised individuals who participated in another prospective observational study that examined outcomes after THR and who were similar in age and sex distribution to our study population. Because these patients were also treated in the same hospitals and came from the same referral area, they were an appropriate comparison group and provided a benchmark as to how the PROSTALAC patients were performing. The average WOMAC scores for joint pain, function and stiffness were significantly better than those reported by patients with OA awaiting hip surgery. However, joint pain, stiffness, function and general health status scores were not as favourable as those of patients who had undergone uncomplicated hip arthroplasty.
What Is A Temporary Hip Replacement | Orthopedic …
In conclusion, treatment of late chronic hip joint infections after THA is a challenging problem. The gold standard remains a two-stage revision arthroplasty using antibiotic-impregnated cement spacers which achieves an infection control rate over 90%. Articulating spacers provide the advantages of maintaining limb length and joint mobility, minimising soft-tissue contracture and scarring, and facilitating second-stage reimplantation and therefore, should be used as the first option of treatment for late chronic hip joint infections.
What Is A Temporary Hip Replacement
3. Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ. Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. 2007;89:871-82
Complications after spacer implantation in the …
13. Fink B, Vogt S, Reinsch M, Büchner H. Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stage revision of infected hip prostheses. 2011;469:3141-7