Double-Layered Antibiotic-Loaded Cement Spacer for Hip Infection: A Report of Two Cases.

Introduction: Septic arthritis of the hip and periprosthetic joint infection (PJI) are serious conditions that can cause joint destruction and severe functional impairment. In cases with advanced joint destruction or implant-related infection, two-stage reconstruction using an antibiotic-loaded cement spacer is widely performed. However, conventional polymethylmethacrylate (PMMA) spacers have limitations, including a short duration of antibiotic release and potential antibiotic inactivation caused by polymerization heat. A double-layered antibiotic-loaded cement spacer consisting of an antibiotic-loaded calcium phosphate paste core covered with PMMA cement has been developed to combine sustained antibiotic release with mechanical stability. Case Report: We report two infected hip cases treated using this novel spacer: One patient with PJI following hemiarthroplasty and one patient with septic arthritis of the hip. In both patients, extensive debridement and implantation of a double-layered antibiotic-loaded cement spacer were performed as the first stage of treatment. Inflammatory markers improved promptly after surgery, and no mechanical complications, including spacer fracture or dislocation, occurred during the interval period. Second-stage total hip arthroplasty was successfully performed in both cases. At the final follow-up, both patients were ambulatory without evidence of recurrent infection. Conclusion: A double-layered antibiotic-loaded cement spacer may provide both effective infection control and mechanical stability during two-stage reconstruction for hip infections. This technique may represent a useful treatment option for the management of septic arthritis of the hip and PJI.