Novel Antibiotic-Loaded Cement Femoral Head Spacer for the Treatment of Advanced Pyogenic Arthritis in Adult Hip

Background: The aim of this study is to present a treatment for end-stage pyogenic arthritis of the hip using a novel cement spacer. This spacer caused less damage to the proximal femoral bone and made the conversion to total hip arthroplasty (THA) more convenient while maintaining the advantages of current cement spacers loaded with antibiotics. Methods: We retrospectively reviewed 10 consecutive cases of hip pyogenic arthritis with joint destruction. These cases occurred from September 2009 to June 2015. In these cases, we used an antibiotic-loaded, cement spacer that was formed in the shape of the femoral head. This spacer rested on multiple screws that were inserted in the remaining neck of the femur. Once the infection subsided, a conversion to THA was performed in all cases. Evaluation included clinical and radiologic outcomes and the development of complications. Results: The mean interval between spacer insertion and conversion to THA was 101.6 days (range, 59-187 days). The mean follow-up period from initial spacer insertion was 44.9 months (range, 15-95 months). All cases underwent noncemented THA following the resolution of the initial infection. The mean Harris Hip Scores at initial visit, before conversion to THA, and on final follow-up were 58.8, 71.0, and 92.5, respectively. No case had any spacer-related complications, recurrence of infection, or dislocation. Conclusion: The treatment of advanced pyogenic arthritis with this novel femoral head spacer technique significantly reduced pain, preserved proximal femoral bone and soft tissue tension, controlled infection, improved function, and allowed for easier conversion to THA.