Handmade spacers for two-stage exchange at the hip.

OBJECTIVE

Two-stage exchange with implantation of a temporary spacer is the gold standard treatment for chronic periprosthetic joint infection of the hip. This article describes a simple and safe technique for handmade spacers at the hip.

INDICATION: Periprosthetic joint infection of the hip. Septic arthritis of the native joint.

CONTRAINDICATIONS: Known allergy against components of polymethylmethacrylate bone cements. Inadequate compliance for two-stage exchange. Patient unfit to undergo two-stage exchange. Bony defect situation at the acetabulum impeding stable reduction of the spacer. Bone loss at the femur jeopardizing stable fixation of the stem. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy.

SURGICAL TECHNIQUE: Tailoring bone cement with antibiotics. Preparation of a metal endoskeleton. Molding of spacer stem and head by hand. Customizing spacer off-sets to bony anatomy and soft tissue tension. Implantation assuring rotational stability at the femur with a bone cement collar. Confirmation of correct position by intraoperative radiography.

POSTOPERATIVE MANAGEMENT: Restricted weight-bearing. Range of motion as possible. Reimplantation after successful treatment of infection.