Article
The one-stage hip prosthesis replacement with injectable antibiotic bone substitute material. The CeraHip study
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Authors
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Thilo Khakzad
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
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Sebastian Meller
- Charité Campus Virchow Klinikum, Berlin, Germany
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Carsten Perka
- CMSC Charité – Universitätsmedizin Berlin, Berlin, Germany
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Sebastian Hardt
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie, Berlin, Germany
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Vincent Justus Leopold
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie, Berlin, Germany
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Michael Müller
- Zentralklinikum Bad Berka, Bad Berka, Germany
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Tobias Winkler
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Julius Wolff Institut, Berlin, Germany
| Published: | October 21, 2024 |
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Outline
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Objectives: Periprosthetic joint infection (PJI) is a major complication following total hip prosthesis implantation and revision. This study aims to investigate the efficacy of single-stage cementless hip revision arthroplasty using gentamicin-induced bone graft substitute (BGS) in addressing PJI and associated bone defects.
Methods: A prospective analysis of twenty patients with confirmed low-grade PJI who underwent single-stage hip revision arthroplasty with implant removal, debridement, lavage, and defect reconstruction was performed. Patients underwent cementless revision arthroplasty using gentamicin-induced calcium sulphate/hydroxyapatite BGS to fill femoral and acetabular defects. Radiographs, adverse events, and patient-reported outcome measures including Harris Hip Score (HHS), EQ-5D-5L, and pain visual analogue scale (VAS) were assessed. Patients received 12 weeks of systemic antibiotics and were followed up at 12 months.
Results and conclusion: The mean age of the cohort was 66.3±8.4 years with ten female and ten male patients. On average 13.2 ml of gentamicin-induced BGS was applied to bone defects. No re-infections occurred during the follow-up period. One patient underwent revision surgery due to aseptic cup loosening, unrelated to BGS use. All cases exhibited good bony consolidation and prosthesis integration at 12 months. Significant improvements were observed in HHS (preoperative mean: 47.7; 12-months follow-up mean: 80; p<0.01), EQ-5D-5L score (preoperative mean: 0.43; 12-month follow-up mean: 0.88; p<0.01), and pain VAS (preoperative mean: 4.7; 12-month follow-up mean: 2.0; p<0.01).
This prospective pilot study is the first study to demonstrate the feasibility and efficacy of single-stage cementless hip revision arthroplasty using gentamicin-induced BGS in managing PJI and associated bone defects. The technique yielded significant improvements in patient-reported outcomes, including functional outcomes, quality of life, and pain levels with low complication rates. These results show the need for larger studies to validate these findings and further establish the role of gentamicin-induced BGS in improving patient care and outcomes for PJI.
