Addressing Antibiotic Hip Spacer Instability via Hybrid Screw-cement Fixation of a Constrained Liner and Cement-rebar Interface Techniques: A Technical Narrative.

Abstract

Prosthetic joint infection is a challenging and devastating complication after total hip arthroplasty. The benchmark for treatment remains two-stage revision arthroplasty, in which an antibiotic-impregnated spacer is used to eradicate the infection. Although several types of spacer constructs have been described, they have historically been associated with high rates of mechanical complications, namely, dislocation, spacer fracture, and periprosthetic femur fracture. Spacer dislocation is the most common, with reported rates as high as 41%. Here, the authors present a surgical technique to improve the mechanical stability of an articulating hip spacer via a hybrid screw-cement fixation technique that allows for joint motion and weight bearing during the treatment period while minimizing the risk of mechanical failure. An additional technique is described to address acetabular bone loss, which has been associated with a higher spacer dislocation rate, through a cement-rebar interface construct.