Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2020; 11(12): 595-605
Published online Dec 18, 2020. doi: 10.5312/wjo.v11.i12.595
Improved patient reported outcomes with functional articulating spacers in two-stage revision of the infected hip
Ewout S Veltman, Dirk Jan F Moojen, Rudolf W Poolman
Ewout S Veltman, Department of Orthopaedic and Trauma Surgery, OLVG, Amsterdam 1091AC, Netherlands
Dirk Jan F Moojen, Orthopaedic and Trauma Surgery, OLVG, Amsterdam 1091AC, Netherlands
Rudolf W Poolman, Department of Orthopaedic Surgery and Joint Research, OLVG, Amsterdam 1091AC, Netherlands
Author contributions: Veltman ES, Moojen DJF and Poolman RW were responsible for the design of the study and drafting and/or revising the manuscript. Data selection and statistical analysis were performed by Veltman ES.
Institutional review board statement: This study was approved by the local medical ethics committee with reference number 15.080.
Conflict-of-interest statement: The authors have no conflict of interest to mention.
Data sharing statement: No additional data are available.
STROBE statement: The STROBE statement was adhered to while constructing the study and writing the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ewout S Veltman, MD, Doctor, Department of Orthopaedic and Trauma Surgery, OLVG, Oosterpark 9, Amsterdam 1091AC, Netherlands. wout.veltman@gmail.com
Received: April 11, 2020
Peer-review started: April 11, 2020
First decision: September 24, 2020
Revised: October 9, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: December 18, 2020
Abstract
BACKGROUND

Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties. Interval spacers can be functional articulating or prefabricated. Functional results of these spacers have scarcely been reported.

AIM

To compare retrospectively the patient reported outcome and infection eradication rate after two-stage revision arthroplasty of the hip with the use of a functional articulating or prefabricated spacer. 

METHODS

All patients with two-stage revision of a hip prosthesis at our hospital between 2003 and 2016 were included in this retrospective cohort study. Patients were divided into two groups; patients treated with a functional articulating spacer or with a prefabricated spacer. Patients completed the Hip Osteoarthritis Outcome Score and the EQ-5D-3L (EQ-5D) and the EQ-5D quality of life thermometer (EQ-VAS) scores. Primary outcomes were patient reported outcome and infection eradication after two-stage revision. The results of both groups were compared to the patient acceptable symptom state for primary arthroplasty of the hip. Secondary outcomes were complications during spacer treatment and at final follow-up. Descriptive statistics, mean and range are used to represent the demographics of the patients. For numerical variables, students’ t-tests were used to assess the level of significance for differences between the groups, with 95% confidence intervals; for binary outcome, we used Fisher’s exact test.

RESULTS

We consecutively treated 55 patients with a prefabricated spacer and 15 patients with a functional articulating spacer of the hip. The infection eradication rates for functional articulating and prefabricated spacers were 93% and 78%, respectively (P > 0.05). With respect to the functional outcome, the Hip Osteoarthritis Outcome Score (HOOS) and its subscores (all P < 0.01), the EQ-5D (P < 0.01) and the EQ-VAS scores (P < 0.05) were all significantly better for patients successfully treated with a functional articulating spacer. More patients in the functional articulating spacer group reached the patient acceptable symptom state for the HOOS pain, HOOS quality of life and EQ-VAS. The number of patients with a spacer dislocation was not significantly different for the functional articulating or prefabricated spacer group (P > 0.05). However, the number of dislocations per patient experiencing a dislocation was significantly higher for patients with a prefabricated spacer (P < 0.01).

CONCLUSION

Functional articulating spacers lead to improved patient reported functional outcome and less perioperative complications after two-stage revision arthroplasty of an infected total hip prosthesis, while maintaining a similar infection eradication rate compared to prefabricated spacers.

Keywords: Two-stage revision, Periprosthetic joint infection, Hip arthroplasty, Functional articulating spacer, Prefabricated spacer, Patient reported outcome

Core Tip: Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties. The functional results of these spacers have scarcely been reported. We retrospectively compared all patients treated with two-stage revision arthroplasty of the hip with a functional articulating or prefabricated spacer between 2003 and 2016. We used 15 functional articulating spacers and 55 prefabricated spacers. Patient reported outcome was significantly better for the functional articulating spacer group, while a similar infection eradication rate was achieved.