Antibiotic-coated spacers for total hip arthroplasty infection

Total hip arthroplasty (THA) infection imposes a significant burden on the patient and the health care system. Two-stage revision with interval placement of an antibiotic-cement spacer is the standard of care for chronic periprosthetic infections. This treatment allows for the direct delivery of antibiotics to the infected tissues, and maintains soft tissue tension to facilitate the re-implantation procedure. Evidence suggests that articulating spacers, compared to nonarticulating designs, enhance postoperative ambulation and make the second-stage procedure less difficult. Prefabricated spacers are easy to use; however, they cannot be used to alter the antibiotic composition and dosage. Custom-molded spacers prepared in the operating room from commercially available kits are a popular option; however, like prefabricated spacers, limited sizes are available and thus, they may be contraindicated in situations with significant bone loss. Custom-made total hip spacers are significantly less expensive than commercially-available options, are useful in cases of bone loss, and optimize patient function prior to re-implantation. An inexpensive cemented femoral stem is covered with antibiotic-loaded bone cement. This is done once the cement has the consistency of dough to prevent interdigitation with the host femur. The authors use at least 3.6 g of tobramycin and 1 g of vancomycin per packet of cement. A thin polyethylene is cemented into the acetabulum, followed by placement of the femoral prosthesis. Combined component position must be optimized to prevent instability.