The effect of endoskeleton on antibiotic impregnated cement spacer for treating deep hip infection

From Jan. 2004 to Dec. 2007, we collected a prospective cohort of consecutive 34 patients who treated with two-stage revision total hip arthroplasty for deep infection of hip joint. In group 1, fifteen patients were treated by a novel design augmented with hip compression screw while nineteen patients were treated by traditional design in group 2.No fracture of cement spacer occurred in group 1 while 6 cases developed spacer failure in group 2. (p < 0.05) There were significant differences in bodily pain and general health perception between groups (p < 0.05).Patients being treated for deep infection of hip joint using cement spacer augmented with stronger endoskeleton have lower pain levels and better joint function between stages.A two-stage revision arthroplasty was suggested as the gold standard treatment among many therapeutic alternatives for deep infections in the hip joint[1-6] Various design of antibiotics impregnated cement prosthesis, either custom made or commercially available[7], reported advantages such as effective local antibiotics delivery, continuation of patient mobility, maintenance of limb alignment, and facilitation of re-implantation, contributed to the good functional recovery after revision total hip arthroplasty(THA) [8-12]. However, fracture of the cement spacer occurred which might decrease ambulation ability and leg length discrepancy [10,11,13], and demand an additional surgery for exchange [9] (Figure 1). The introduction of metallic endoskeleton such as Kirschner wires [11,14], Rush rod[8,10], hip compression screws, intramedullary nail[15],and even custom made rod[16] aimed to increase the strength of the construct. Among those designs of endoskeleton, hip compression screw was of particular interest because it was privileged by providing angular stability that augmented the weakest link of the cement spacer [17]. It was possible that mechanical instability, pain, and cement spacer dislocation might be avoided through increasing the