Impact of introducing custom-made articulating spacers: A retrospective cohort study on two protocols for two-stage...

Two-stage revision is the most common treatment for chronic periprosthetic joint infection of the hip, involving a resection arthroplasty with or without placement of an antibiotic-loaded spacer, followed by antibiotic therapy before reimplantation.

To compare the outcomes and complications of two consecutive treatment protocols for two-stage revision arthroplasty of the infected hip: One using Girdlestone with an antibiotic holiday, the other using custom-made articulating spacers (CUMARS) without an antibiotic holiday.

In this retrospective study, two consecutive cohorts were compared. Group A (2017-2020) underwent two-stage revision with a Girdlestone and an antibiotic holiday before reimplantation, while Group B (2020-2023) received CUMARS whenever possible, and no antibiotic holiday, or a Girdlestone if indicated. The primary outcome was successful infection eradication after one year. Secondary outcomes included surgical duration, length of hospital stay, weight-bearing allowance, discharge destination, and complications.

A total of 98 patients were included: 39 patients in Group A and 59 patients in Group B. Successful infection eradication after one year was achieved in 69% of Group A and 83% of Group B (P = 0.164). Patients in Group B were more frequently allowed to bear weight (64% vs 18%, P < 0.001), had a shorter in-hospital stay (9 vs 16 days, P < 0.001), and were more often discharged home after the first surgery (48% vs 24%, P = 0.048). No significant differences were found in (mechanical) complications.

A protocol including CUMARS is a safe and effective treatment, offering faster recovery, shorter length of hospital stay, and enabling more patients to return home during the interval. This reduces strain on patients and the healthcare system, potentially saving costs, without compromising infection control or increasing (mechanical) complications.