Comparing the use of preformed vs hand-made antibiotic spacer cement in two stages revision of hip periprosthetic infection.

Background: The number of periprosthetic joint infections (PJI) is continuously increasing because of the increasing number of arthroprostheses performed every year. Two-stage revision, using antibiotic-loaded spacers, remains the gold standard for their treatment. The aim of our study is to compare the use of preformed vs hand-made spacers in hip arthroplasty infections evaluating infection eradication, bone loss and clinical/functional outcomes.

Methods: From January 2010 to December 2017 we performed a prospective nonrandomized study. We pooled 50 patients affected by infected hip joint replacements, and divided them in 2 groups, one receiving commercially preformed spacers and the other receiving hand-made spacers. The study endpoint was set at 12 months. Intra-operative and peri-operative complications, Harris Hip Score (HHS), Short Form 12 Health Survey, intra-operative and radiological evaluation of bone loss were collected. Data were analyzed using descriptive statistics, T-test and Fisher Exact test.

Results: We found a statistically significant differences (p < 0.05) between the two groups in favour of the VancogenX group for the following variables: surgical time, first and second stage intraoperative complication rates, infection eradication. Moreover, the preformed-spacers group had better results in the preservation of bone stock, even though the difference was not statistically significant (p > 0.05).

Conclusion: Our results support the use of preformed antibiotic spacers, even though more studies are needed.