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Management of Antibiotic Hip Spacer Instability: Hybrid Screw and Cement Fixation of a Constrained Liner and Cement and Rebar Interface Technique

March 01, 2020

Contributors: Frank A Liporace, MD, FAAOS; Richard A Pizzo, DO; Richard S Yoon, MD; Jay Patel, DO

Keywords: Complications; Dislocations; Infection

Periprosthetic joint infection is a challenging and devastating complication after total hip arthroplasty. The preferred method for the management of periprosthetic joint infection after total hip arthroplasty is two-stage revision hip arthroplasty, in which an antibiotic-impregnated spacer is placed to eradicate the infection. Although several types of spacer constructs have been described, they are associated with high rates of mechanical complications, namely dislocation, spacer fracture, and periprosthetic femur fracture. This video describes a hybrid and screw cement fixation technique to improve the mechanical stability of an articulating hip spacer. This technique allows for joint motion and weight bearing during the treatment period and minimizes the risk of mechanical failure. The case presentation of a 79-year-old man with an infected right total hip arthroplasty implant is discussed. The video also describes the use of a cement and rebar interface construct to manage acetabular bone loss, which is associated with a higher rate of spacer dislocation.