Comparison of complications associated with commercially available and custom-made articulating spacers in two-stage total hip arthroplasty revision

Background: Two-stage revision with interim placement of an articulating antibiotic-loaded spacer is the "gold standard'' for prosthetic hip joint infection treatment. However, commercially available and custom-made articulating spacer options exist. This study presents a comparison of these two spacer types in terms of interim complications (periprosthetic fracture, spacer dislocation, infection), post second-stage infection control, and a minimum 2-year functional and general health outcomes. Methods: Seventy-eight patients between January 1999 and August 2008 were treated with a two-stage revision, with placement of an articulating spacer during the interim period. Interim complication data, radiographic evaluation, and infection follow-up status were retrospectively reviewed. Additionally, modified Harris Hip Score and Short Form-12v2 scores were collected at a mean follow-up of 58.3 months (range, 24.3-135.3 months). Results: There were no statistically significant differences in interim complication rates between commercially available (n = 27) (prefabricated, n = 13; mold systems, n = 14) and noncommercial custom-made (n = 51) articulating spacer groups. However, there was a higher recurrence of infections after the second-stage procedure in the custom-made spacer group (21.6% compared with 0.0%) (P = 0.001). Similar functional and general health outcomes, as well as instances of prosthesis loosening, were found between spacer types at last office follow-up visit. Conclusions: These data suggest that custom-made articulating spacers, which allow flexibility in construction at often cheaper costs than commercially available options, offer similar performance in terms of mechanical complications. However, more emphasis may need to be placed on antibiotic choice and concentration to decrease the incidence of infection recurrence.