Infection continues to be one of the most feared complications of total hip arthroplasty. Despite many advances over the past three decades, this infrequent complication continues to undermine an otherwise highly predictable and successful procedure. The prosthesis of antibiotic-loaded acrylic cement (PROSTALAC; DePuy, Warsaw, Indiana) is a temporary hip-replacement articulated spacer intended for patients who need a two-stage exchange arthroplasty for the treatment of a confirmed or suspected infection at the site of a total hip replacement. This device has received approval from the United States Food and Drug Administration as a humanitarian use device. (This humanitarian device has been authorized by federal law as a short-term total hip replacement [THR] in patients who need a two-stage procedure to treat a confirmed infection of their THR and where vancomycin and tobramycin are the most appropriate antibiotics for treatment of the infection based on the susceptibility pattern of the infecting microorganism[s]. The effectiveness of this device for this use has not been determined.) The early experience with 135 patients who were treated with the PROSTALAC implant is reported. Initial experience has also been reported in previous publications 1-2.
The PROSTALAC system ( Fig. 1 ) is a temporary total hip replacement prosthesis that is used as a first-stage exchange articulated spacer and provides for local delivery of antibiotics at the infection site. It comprises a short or long-stem cobalt-chrome-alloy core femoral implant; a one-piece, ultra-high molecular weight polyethylene, snap-fit acetabular component; a standard 32-mm cobalt-chrome modular femoral head; and a polymethylmethacrylate stem centralizer. Polymethylmethacrylate bone cement and the antibiotic in powder form are the remaining components of the system.
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