Optimization of the first stage of hip revision in 2-stage surgery to replace infected artificial hips using a new molding spacer tool

Introduction The first stage of two-step surgery to replace infected hip suggests the intraoperative fabrication of an articulating cement spacer. A critical step is manual holding the metal reinforcement in the mold for 8–12 minutes while the bone cement cures, which increasing the overall surgical time. Optimizing this stage is essential.

The objective was to evaluate the effectiveness of the first stage of hip revision in 2-stage surgery optimized with a new device for fixing reinforcement in the manufacture of a cemented spacer for the hip joint.

Material and methods A new device (RU Patent No. 232924 U1), made of medical-grade AISI304 stainless steel, which is reusable and sterilizable, allows for the fixation of reinforcement used to manufacture hip articulating spacers in a clamp and their positioning over the center of a mold cell sized to fit the acetabulum (diameters 46–62 mm in 2 mm increments). With the cell filled with cement, the reinforcement was inserted to the specified depth and secured with the device. After 8–12 minutes, to allow polymerization completed, the construct was removed for cementation of the femoral component. A retrospective analysis of 85 patients with infectious coxitis surgically treated between 2023 and 2026 was conducted: the spacer was made by manual retention of reinforcement in the control group (n = 51) and the spacer was made using a new fixation device in the study group (n = 34). Total operative time (min), the frequency of spacer revisions, and early complications were assessed. The groups were comparable for key parameters.

Results Operating time was reduced by 13.7 minutes in the study group ((84.5 ± 8.9) min versus (98.2 ± 12.5) min, p = 0.008). The frequency of intraoperative spacer adjustments decreased fivefold (6 % versus 29 %, p = 0.012). No dislocations were recorded early post-op in either group. No significant differences in the accuracy of radiographic parameters (offset, neck-to-shaft angle) were found.

Discussion There are no publications reporting similar devices for the fabrication of the acetabular component of the hip articulating spacers. Patients with an underlying infectious process (tuberculous or purulent coxitis) and frequent comorbidities (HIV, hepatitis) may benefit with even a relatively small reduction in surgical time improving the prognosis. The lack of need for spacer modification preserves the integrity of the femoral head surface and ensures a more uniform distribution of the antibiotic in the cement.

Conclusion The device offered can be recommended for clinical implementation reducing surgical time by an average of 14 minutes and the frequency of spacer modifications.

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