An antibiotic hip spacer is a temporary implant used in hip replacement surgery when an infection develops around the joint. This device is employed as part of a two-stage surgical approach to treat periprosthetic joint infection (PJI), a common complication after hip replacement. The spacer helps manage the infection and prepares the area for a new, permanent hip implant.
What is an Antibiotic Hip Spacer
An antibiotic hip spacer is a temporary device designed to treat infection within the joint space after a hip replacement. It serves as an interim measure in a two-stage revision surgery, where the infected prosthetic components are first removed. The spacer is typically made from bone cement, such as polymethyl methacrylate (PMMA), which is infused with high doses of antibiotics like gentamicin or vancomycin.
This antibiotic-loaded cement delivers a concentrated amount of antimicrobial agents directly to the infection site. This localized delivery helps eradicate bacteria while minimizing systemic side effects. Additionally, the spacer maintains the joint space and prevents soft tissue contracture, simplifying the subsequent implantation of a permanent hip prosthesis.
Walking with an Antibiotic Hip Spacer
Walking with an antibiotic hip spacer is often possible, but it comes with significant limitations. Patients are typically advised to bear only partial weight on the affected leg, often requiring the use of assistive devices like crutches or a walker. This partial weight-bearing helps protect the temporary spacer and the surrounding tissues.
The extent of mobility depends on the patient’s condition, the surgeon’s specific instructions, and the type of spacer used. Articulating spacers, which allow for some movement, generally offer more comfort and a greater range of motion than non-articulating spacers. However, strenuous activities and movements that put excessive stress on the hip must be avoided to prevent complications like spacer dislocation or fracture.
The Spacer Timeline and Next Steps
An antibiotic hip spacer remains in place for a temporary period, typically ranging from several weeks to a few months, allowing sufficient time for the infection to clear. Durations typically range from six weeks to around 180 days, or an average of five months. During this time, the medical team closely monitors the infection’s progress.
Monitoring usually involves regular blood tests, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which indicate inflammation levels. Joint fluid analysis may also be performed to assess the presence of bacteria and confirm infection eradication. Once the infection is resolved, the second stage of surgery involves removing the temporary spacer and implanting a new, permanent hip prosthesis.
Important Considerations While Living with a Spacer
Living with an antibiotic hip spacer requires careful management. Patients may experience discomfort or pain while the spacer is in place, which healthcare providers can help manage with appropriate pain relief strategies.
Monitoring for signs of worsening infection is also important, including fever, increased pain, redness, swelling, or unusual discharge from the surgical site. Activity restrictions are strict to prevent complications; patients must diligently follow weight-bearing and movement limitations to avoid dislocation or spacer fracture. Maintaining good wound care and general hygiene is advised, and regular follow-up appointments with the surgeon and physical therapy sessions are necessary to ensure proper healing and prepare for the final hip replacement.