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Open Access Research article

Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

Carlo L Romanò1*, Delia Romanò1, Enzo Meani2, Nicola Logoluso1 and Lorenzo Drago3

Author Affiliations

1 Dipartimento di Chirurgia Ricostruttiva e delle Infezioni Osteo-articolari Istituto Ortopedico I.R.C.C.S. Galeazzi - Via Riccardo Galeazzi, 4 - 20161 - Milano - Italy

2 Centro di Chirurgia Osteo-articolare Settica Istituto Ortopedico Gaetano Pini - Via G. Pini, 9 - 20122 - Milano - Italy

3 Laboratorio analisi e microbiologia Istituto Ortopedico I.R.C.C.S. Galeazzi - Via Riccardo Galeazzi, 4 - 20161 - Milano - Italy

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BMC Infectious Diseases 2011, 11:129  doi:10.1186/1471-2334-11-129

Published: 16 May 2011



Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol.


Nineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS]) and hip joint function (Harris Hip score).


The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104) months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84) pre-operatively to 18 (range, 0 - 38) prior to spacer removal and to 8 (range, 0 - 15) at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment.


Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.