Handmade spacers for two-stage exchange at the hip

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Biomaterials Engineering

Background:

• Chronic periprosthetic joint infection (PJI) of the hip is a significant complication following hip arthroplasty.
• Two-stage exchange with a temporary spacer is the established treatment protocol for hip PJI.
• Current methods for spacer fabrication can be complex and may not address unique anatomical challenges.

Purpose of the Study:

• To describe a simple, safe, and effective technique for fabricating custom, handmade antibiotic-eluting spacers for hip PJI.
• To detail the surgical steps involved in creating and implanting these custom spacers.
• To highlight the adaptability of this technique for various bony and soft tissue conditions.

Main Methods:

• The technique involves tailoring antibiotic-loaded bone cement around a metal endoskeleton.
• Spacers are molded by hand to match the patient's specific anatomy, including customized offsets.
• Intraoperative radiography is used to confirm accurate placement and rotational stability, particularly with a bone cement collar.

Main Results:

• The described method allows for the creation of patient-specific spacers that address complex bony defects and soft tissue requirements.
• Successful implantation ensures rotational stability, a critical factor for subsequent reimplantation.
• This technique offers a viable alternative for patients with contraindications to standard spacer fabrication or implantation.

Conclusions:

• Handmade antibiotic spacers provide a customizable and accessible solution for managing hip periprosthetic joint infection.
• This technique simplifies the creation of temporary spacers, potentially improving surgical efficiency and patient outcomes.
• Further studies are warranted to evaluate long-term efficacy and compare outcomes with commercially available spacers.