Abstract

The authors have retrospectively evaluated the use of a temporary spacer with gentamicin-loaded cement in the treatment of infected total hip arthroplasty with two-stage reimplantation. In 1995 and 1996, three patients, 2 females and 1 male, aged respectively 65, 58 and 50 years, underwent a two-stage revision with a temporary spacer covered with gentamicin cement. In two cases, there was a draining sinus with a multiresistant Staphylococcus aureus in one case, and an Enterobacter cloacae sensitive to several antibiotics in the other. In the third case, there was bipolar loosening 7 months after multi-resistant Staphylococcus aureus septicemia. The prosthetic components and cement were removed, and synovectomy was performed. The hip cavity was filled with a small monolithic femoral stem covered with a mantle of cement and topped with a cement sphere the diameter of which was identical to that of the removed cup. Patients were kept on appropriate antibiotic therapy. The second stage was initiated after normalization of fibrinogen and CRP (6 to 8 weeks after removal of the components). All patients received specific antibiotics for at least 3 months after reimplantation. After the first stage, the patient was discharged home with partial weight-bearing and physiotherapy. No dislocations of the spacer were noted. After the second stage, all patients regained 80° flexion in the hip and were pain-free without any cases of dislocation. The spacer provides greater patient comfort and mobility, prevents retraction and fibrosis, and makes reimplantation surgery easier without serious complications and with good functional results. At three-year follow-up, there was no recurrent infection.