ArticleBMC musculoskeletal disorders2021
Management of peri-prosthetic joint infection and severe bone loss after total hip arthroplasty using a long-stemmed cemented custom-made articulating spacer (CUMARS).
Article in BMC musculoskeletal disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 12 citations in OpenAlex.
- Cure rate of infections is not an argument for spacer in two-stage revision arthroplasty of the hip.Archives of orthopaedic and trauma surgery · 2023Trial
- Management of Periprosthetic Joint Infections: A Multidisciplinary Approach.Antibiotics (Basel, Switzerland) · 2026Review
- The Influence of Antibiotic-Loaded Bone Cement Spacer Type on Outcomes of the First Stage of a Revision Total Hip Arthroplasty.Antibiotics (Basel, Switzerland) · 2025Article
- Combinational Periprosthetic Hip Joint Infection and Fracture: A Two-Stage Revision with Long Femoral Stem Spacers.Malaysian orthopaedic journal · 2025Article
- Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses-A Review of the Literature.Antibiotics (Basel, Switzerland) · 2023Review
- Articulating spacers: what are available and how to utilize them?Arthroplasty (London, England) · 2023Review
- Palmitic acid coating of allogeneic cancellous bone for local antibiotic treatment: A porcine impaction bone grafting model.Journal of orthopaedics · 2023Article
- One-Stage Hip Revision Arthroplasty Using Megaprosthesis in Severe Bone Loss of The Proximal Femur Due to Radiological Diffuse Osteomyelitis.Tropical medicine and infectious disease · 2021Article
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Authors and funding
8 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is little evidence on techniques for management of peri-prosthetic infection (PJI) in the context of severe proximal femoral bone loss. Custom-made articulating spacers (CUMARS) utilising cemented femoral stems as spacers was described providing better bone support and longer survival compared to conventional articulating spacers. We retrospectively report our experience managing PJI by adaptation of this technique using long cemented femoral stems where bone loss precludes use of standard stems.
methodsPatients undergoing 1st stage revision for infected primary and revision THA using a cemented long stem (> 205 mm) and standard all-polyethylene acetabulum between 2011 and 2018 were identified. After excluding other causes of revision (fractures or aseptic loosening), Twenty-one patients remained out of total 721 revisions. Medical records were assessed for demographics, initial microbiological and operative treatment, complications, eradication of infection and subsequent operations. 2nd stage revision was undertaken in the presence of pain or subsidence.
resultsTwenty-one patients underwent 1st stage revision with a cemented long femoral stem. Mean follow up was 3.9 years (range 1.7-7.2). Infection was eradicated in 15 (71.4%) patients. Two patients (9.5%) required repeat 1st stage and subsequently cleared their infection. Three patients (14.3%) had chronic infection and are on long term suppressive antibiotics. One patient (4.8%) was lost to follow up before 2 years. Complications occurred in seven patients (33%) during or after 1st stage revision. Where infection was cleared, 2nd stage revision was undertaken in 12 patients (76.5%) at average of 9 months post 1st stage. Five (23.8%) CUMARS constructs remained in-situ at an average of 3.8 years post-op (range 2.6-5.1).
conclusionsOur technique can be used in the most taxing of reconstructive scenarios allowing mobility, local antibiotic delivery, maintenance of leg length and preserves bone and soft tissue, factors not afforded by alternative spacer options.
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