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Purpose of the study – to estimate the effectiveness of periprosthetic infection of the hip using different modifications of spacers. Material and methods. The authors analyzed treatment outcomes of 168 patients with clinical and laboratory signs of infection after hip replacement. Patients were divided into two groups: 87 patients (control group) underwent a standard two-stage revision hip joint arthroplasty with a spacer; 81 patients (test group) underwent preoperative examination procedure suggested by authors that was the basis for future selection of surgical technique using various spacers and customized follow up treatment. Results. The authors observed in test group a marked reduction of microbial contamination of periprosthetic tissue: 1 month after spacer implantation the test group features four times less pathogens as compared to control group. Need for re-revision was decreased by 1.8 times, twofold decrease in need for spacer revision after secondary examination, 1,4 less duration of hospital stay and 1,8 less disability duration was observed as compared to outcomes in control group after standard treatment approach. Functional outcomes of patients in test group in 6 months after secondary examination in regard of infectious complication after hip replacement were characterized by better Harris Hip scores as compared to control group. 6-12 months after revision the patients of test group were 1.3 times less reporting limitations of functional activity, twice less using support means and 2.2 times less needed pain medication. Conclusion. Complex treatment that includes preoperative examination, evaluation of bone defect volume, algorithm of choosing the antibiotic spacer type and its implantation technique as well as customized postoperative follow up treatment was proved to be efficient and results in stable eradication of chronic suppurative inflammation.

About the authors

R. N. Komarov

Privolzhsky Federal Research Medical Centre of the Ministry of Health 18, Verkhne-Volzhskaya nab., Nizhny Novgorod, 603155, Russia

Author for correspondence.
Junior Researcher Scientist Department of Purulent Surgery Russian Federation

V. N. Mitrofanov

Privolzhsky Federal Research Medical Centre of the Ministry of Health 18, Verkhne-Volzhskaya nab., Nizhny Novgorod, 603155, Russia

Cand. Sci. (Med) Head of Department of Purulent Surgery Russian Federation

A. V. Novikov

Privolzhsky Federal Research Medical Centre of the Ministry of Health 18, Verkhne-Volzhskaya nab., Nizhny Novgorod, 603155, Russia

Dr. Sci. (Med), Trauma and Orthopedic Surgeon Russian Federation

S. B. Korolev

Privolzhsky Federal Research Medical Centre of the Ministry of Health 18, Verkhne-Volzhskaya nab., Nizhny Novgorod, 603155, Russia
Novgorod State Medical Academy of the Ministry of Public Health
10/1, pl. Minina i Pozharskogo, Nizhny Novgorod, 603155, Russia

Dr. Sci. (Med), professor, the Head of Department of Traumatology, Orthopaedics and Field Surgery, Nizhny Novgorod State Medical Academy; Trauma and Orthopedic Surgeon, Privolzhsky Federal Research Medical Centre of the Ministry of Health Russian Federation


  1. Вырва О.Е., Бурлака В.В., Малык Р.В., Озеров К.И. Инфекционные осложнения первичного тотального эндопротезирования тазобедренного и коленного суставов. Ортопедия, травматология и протезирование. 2011;3:60-67.
  2. Ежов И.Ю., Корыткин А.А., Бобров М.И., Загреков В.И., Шебашев А.В. проблема гнойно-некротических и ранних гнойно-септических осложнений при эндопротезировании тазобедренного сустава. Вестник Национального медико-хирургического Центра им. Н.И. Пирогова. 2010;5(1):22-25.
  3. Куляба Т.А. Костная аллопластика при ревизионном эндопротезировании коленного сустава. Травматология и ортопедия России. 2009;3:148-150.
  4. Лю Бо, Тихилов Р.М., Шубняков И.И., Разоренов В.Л., Денисов А.О., Божкова С.А., Артюх В.А., Клиценко О.А., Тотоев З.А. эффективность первого этапа двухэтапной ревизии при параэндопротезной инфекции тазобедренного сустава. Травматология и ортопедия России. 2014; 3 (73):5-14. doi: 10.21823/2311-2905-2014-0-3-5-14.
  5. Николенко В.К., Буряченко Б.П., Давыдов Д.В. Особенности ревизионного эндопротезирования тазобедренного сустава по поводу инфекционных осложнений. Инфекции в хирургии. 2008;6(2):50-55.
  6. Павлов В.В., Садовой М.А., Прохоренко В.М. Современные аспекты диагностики и хирургического лечения пациентов с перипротезной инфекцией тазобедренного сустава (обзор литературы). Травматология и ортопедия России. 2015;1:116-128. doi: 10.21823/2311-2905-2015-0-1-116-128.
  7. Пичхадзе И.М., Кузьменков К.А., Жадин А.В., Цискарашвили А.В., Пичхадзе Е.И., Данелия Л.М., Реквава Г.Р., Шулашов Б.Н. Лечение больных с гнойно-воспалительными осложнениями после эндопротезирования тазобедренного сустава. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2009;
  8. (3):45-50.
  9. Шильников В.А., Тихилов Р.М., Денисов А.О. Болевой синдром после эндопротезирования тазобедренного сустава. Травматология и ортопедия России. 2008;(2): 106-109.
  10. Ben-Lulu O., farno A., gross A.E., Backstein D.J., Kosashvilj y., Safir O.A. A modified cement spacer technique for infected total hip arthroplasties with significant bone loss. Arthroplasty. 2012;27(4):613-619. doi: 10.1016/j.arth.2011.06.031.
  11. Crockarell J.R., Hanssen A.D., Osmon D.R., Morrey B.f. Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg. 1998;80-A:1306-1313.
  12. Cooper H.J., Della Valle C.J. The two-stage standard in revision total hip replacement. Bone Joint J. 2013;95-B(11 Suppl A):84-87. doi: 10.1302/0301-620x.95B11.32906.
  13. Engesater L.B., Dale H., Schrama J.C., Hallan g., Lie S.A. Surgical procеdures in the treatment of 784 infected THAs reported to the Norwegian arthroplasty register. Acta orthop. 2011;82(5):530-537. doi: 10.3109/17453674.2011.623572.
  14. fink B., grossmann A., fuerst M. Two-stage cementless revision of infected hip endoprotheses. Clin orthop relat res. 2009; 467(7): 1848-1858. doi: 10.1007/s11999-008-0611-y.
  15. Garvin K.L., Konigsberg B.S. Infection following total knee arthroplasty: prevention and management. Instr Course Lect. 2012;61:411-419.
  16. Lee K., goodman S.B. Current state and future of joint replacements in the hip and knee. Expert rev Med Devices. 2008;5(3):383-93. doi: 10.1586/17434440.5.3.383.
  17. Mariconda M., Ascione T., Balato G., Rotondo G., Smeraqila F., Costa G.G., Conte M. Sonication of antibiotic-loaded cement spacers in a two-stage revision protocol for infected joint arthroplasty. BMC Musculoskelet Disord. 2013;24;14:193. doi: 10.1186/1471-2474-14-193.
  18. Neumann D., Hofstaedter T., List S. Two-stage cementless revision of late total hip arthoplasty infection using a premanufactured spacer. Arthroplasty. 2012;27(7): 1397-1401. doi: 10.1016/j.arth.2011.10.022.
  19. Wang S. Antibiotic-impregnated cement temporary spacer for surgical treatment of osteomyelitis and nonunion of bone caused by intramedullary nailing. Zhongguo Xiu Fu Chong JianWai Ke ZaZhi. 2011;25(8):972-975.
  20. Waldman B.J., Hostin E., Mont M.A., Hunfergord D.S. Infected total knee arthroplasty treated by arthroscopic irrigation and debridement. Arthroplasty. 2000;15:430-436. doi: 10.1054/arth.2000.4637
  21. Winkler H. Bone grafting and one-stage revision of THR – biological reconstruction and effective antimicrobial treatment using antibiotic impregnated allograft bone. Hip Int. 2012; 22(Suppl 8):S62-68. doi: 10.5301/HIP.2012.9572.

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