Antibiotic-loaded spacers in hip periprosthetic joint infections

Two stage revision with antibiotic loaded spacers is the gold standard for the treatment of periprosthetic joint infections, with a high rate of success in avoiding infection recurrence. In literature there is a great variability of data about this procedure, leading surgeons not to have clear reference points about it. We reviewed 28 articles of literatures of last ten years on online databases (PubMed, Scopus, Embase) in order to analyze several outcomes: diagnosis, surgical approach, type of spacer and cement used, timing for second stage revision (interstage duration), rate of success, complications. Diagnosis was performed with a combination of clinical, laboratory and radiological parameters; postero-lateral approach was the most common approach used and a preformed, encased in gentamicin impregnated acrylic cement spacer was used in most cases. We found a mean success rate of 91.4%, 6 of 29 studies reported a 100% effectiveness in eradicate the infection, while in 15 of 28 we found an effectiveness >95% in eradicate the infection (no recurrence). The mean waiting time for second stage revision surgery was 14.5 weeks. Most frequent interstage complications were dislocation of the spacer, followed by infection recurrence -spacer exchange and fracture of the femur. Second stage most frequently reported complication is infection recurrence followed by the need for revision for different reasons and final implant dislocation. Despite the great success rate of this procedure, the surgeon has to be aware of possible complications deriv-ing from that, in particular dislocation, fractures and infection recurrence and their management.