Uso prolongado de espaciador en infección de cadera: Nueva modalidad de tratamiento en dos tiempos

Rogelio Freddy Rey; Viviana Teske

Authors

Rogelio Freddy Rey Universidad de la República, Facultad de Medicina, Clínica de Traumatología y Ortopedia. Profesor Adjunto. Instituto Nacional de Ortopedia y Traumatología, Subdirector. Traumatólogo de Cooperativa Médica de Canelones (COMECA) y del Centro de Asistencia del Sindicato Médico del Uruguay (CASMU), Banco de Prótesis y Sanatorio Americano
Viviana Teske Centro de Asistencia del Sindicato Médico del Uruguay (CASMU). Traumatóloga

Keywords:

BONE CEMENTS, PROSTHESIS-RELATED INFECTIONS, HIP PROSTHESIS

Abstract

Objective: two-stage revision is the standard treatment of prosthesis infection. The present study defines a new therapeutic approach, delaying the second procedure as long as the spacer is useful and allows for an appropriate clinical functioning.
We have failed to find studies that show the evolution of spacers over a long period of time.
Method: we conducted a retrospective assessment of 49 patients with hip infection who had a handmade spacer between one and nine years. Out of these 49 patients, seven died, 13 required a second procedure and 27 still have the spacer, the average being four years.
Results: the second procedure was needed due to acetabular cement breakage (five cases), discomfort (five cases) and other reasons (three cases). There were two infection relapses, three and five years after surgery.
The 27 patients who still have the spacers in place evidenced a significant improvement of the clinical score compared to the postoperative condition, none of them was willing to undergo a second procedure, and their X-rays did not show bone stock alterations in the evolution. There was a single case of relapse, being it diagnosed upon the second procedure, where a new spacer was used.
Conclusions: two-stage procedure surgery happens to be an excellent way to control infection and the spacer used achieves clinical results that are so good in the intermediate time that it enables to delay the second procedure until patients so require it, being it a final solution in old age or terminal patients.

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