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Two-Stage Revision Hip Arthroplasty for Infection: Comparison Between the Interim Use of Antibiotic-Loaded Cement Beads and a Spacer Prosthesis
Pang-Hsin Hsieh, MD1; Chun-Hsiung Shih, MD1; Yu-Han Chang, MD1; Mel S. Lee, MD1; Hsin-Nung Shih, MD1; Wen-E Yang, MD1
1 Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street 333, Kweishian, Taoyuan, Taiwan. E-mail address for P.-H. Hsieh: hsiehph@adm.cgmh.org.tw
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, and the Department of Orthopedics, Chung Shan Hospital, Taipei, Taiwan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Sep 01;86(9):1989-1997
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Background: A two-stage revision is a well-accepted method for the treatment of a deep infection of a hip with a joint implant. In the present study, the results associated with the interim use of antibiotic-loaded cement beads were compared with those associated with the interim use of an antibiotic-loaded cement prosthesis.

Methods: One hundred and twenty-eight consecutive patients who were managed with a two-stage revision hip arthroplasty for the treatment of an infection were followed clinically and radiographically for an average of 4.9 years. Cement beads were implanted following resection arthroplasty in the first seventy hips, and a custom cement prosthesis was implanted in the subsequent fifty-eight hips.

Results: There was no evidence of recurrent infection in 122 patients (95.3%); the infection-free rates in both groups were similar. The use of a spacer prosthesis was associated with a higher hip score, a shorter hospital stay, and better walking capacity in the interim period; a decreased operative time, less blood loss, and a lower transfusion requirement at the time of reimplantation; and fewer postoperative dislocations.

Conclusions: The present study supports the safety and efficacy of the routine use of an antibiotic-loaded cement prosthesis in the interim between the stages of a two-stage revision procedure for the treatment of an infection at the site of a hip arthroplasty.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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