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Stability of Osteoremedies Remedy Hip Spacer for Two-Stage Revisions of Prosthetic Joint Infections: Single Center Analysis

Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION Following a prosthetic joint infection (PJI) of a total hip arthroplasty (THA), two-stage revisions using temporary antibiotic loaded spacers have become a key element of the strategy for infection eradication. These spacers bear risks of mechanical failures leading to inter-stage complications such as loosening, dislocation and fracture. The likelihood of these complications is multifactorial including, but not limited to, the offset between the head and stem, candidacy, type of spacer, and use of supplemental bone cement for stability. This study aims to investigate the stability of OSTEOREMEDIES® REMEDY® modular antibody-loaded hip spacer in patients who underwent two-stage revisions. METHODS An IRB approved retrospective study identified patients (n=18) for whom OSTEOREMEDIES® second-generation pre-molded antibiotic spacers were used during the first stage of their two-stage revision arthroplasties for their hip PJI. Patient demographics and treatment variables, offset between the head and stem, and outcome variables were evaluated. Imaging from post-spacer insertion and most recent follow-up was compared to calculate changes in distance between the head and stem pieces of the spacer (Fig. 1). Post-operative imaging was used to determine the number of threads on the femoral stem piece screwed into the head piece (Fig. 1). RESULTS Eighteen patients who used OSTEOREMEDIES® REMEDY® hip spacer were identified (Table 1). Average age was 59 years (26-79 yrs). Sizes of femoral head and stem components used were 40, 46, 54 mm and 110, 117, 227 mm, respectively. Two patients used only head components. One patient experienced spacer dislocation. One patient experienced spacer fracture (Fig. 2). Spacers were in-situ for an average of 176 days (2-20 months). Of patients who used both spacer pieces, supplemental cement was used in 10, but not in 6. Patients who used supplemental cement had an average difference in distance of -0.15 mm (-0.5 to 0.3 mm). Patients who did not use supplemental cement had an average difference in distance of 0.78 mm (0-3.44 mm). Average degree of threading of femoral head onto the stem piece was 7.75 threads (4-9 threads). All PJI’s were eradicated with this spacer. DISCUSSION In this series, the OSTEOREMEDIES® second-generation pre-molded antibiotic hip spacer proved to be a convenient and effective option during two-stage revisions for managing PJIs, though it demonstrated a small risk of implant fracture and dislocation. This spacer demonstrated only 1 fracture and 1 dislocation of the 16 patients who used both stem and head pieces. It is likely that the addition of supplemental cement, particularly in patients with excessive loading such as trauma or BMI >30, and considering patient-specific risk factors to determine the most efficient offset between the head and stem pieces using thread count will likely contribute towards decreasing the risk of fracture or dislocation. Limitations include small number of patients and the quality of X-ray imaging in patients’ charts. SIGNIFICANCE/CLINICAL RELEVANCE Using two-stage revisions as a part of a comprehensive treatment strategy to manage prosthetic joint infections of total hip arthroplasties involves the use of various types of antibiotic-loaded spacers, though these spacers sometimes carry risks of mechanical failures. These findings demonstrate that the OSTEOREMEDIES® REMEDY® modular antibody-loaded hip spacer is an effective option in two-stage revisions and the use of supplemental bone cement along with the degree of offset between the head and stem pieces likely contribute to its stability, particularly in patients with excessive loading.
DOI: 10.60118/001c.143382
Language: English
Subfield: Surgery
Field: Medicine
Open Access status: hybrid
OpenAlex ID: W4415353570
FWCI:
Cites: 10
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