Article Text

Download PDFPDF
Novel custom made composite spacer for first-stage revision total hip replacement in the presence of extensive acetabular/femoral bone loss with abductor deficiency
  1. Cameron Douglas Brown and
  2. Jibu John Joseph
  1. Trauma and Orthopaedic Surgery, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
  1. Correspondence to Cameron Douglas Brown; cameronbrown{at}


A two-stage revision total hip replacement (THR) remains the gold standard for treating chronic periprosthetic joint infection. The goals for the first stage are twofold: (1) remove infected tissue/implants, obtaining tissue samples for culture; (2) deliver local antibiotics and maintain hip function with a prosthesis with antibiotic-loaded acrylic cement. With extensive bone loss prefabricated spacers are not sufficient, therefore customised spacers are required. The current technique, coating cephalomedually femoral nail in cement, is complex, time consuming, functions poorly and causes wear debris from excessive friction at the femoral/acetabular articulation. We report a technique to create a custom made composite spacer using a short femoral nail, standard Exeter femoral stem (Stryker), Trident acetabular cup (Stryker) and polymethyl methacrylate (PMMA) bone cement with antibiotics. This technique restores hip biomechanics and gives a stable articulation, even in the presence of abductor deficiency, due to dual mobility bearings.

  • hip implants
  • orthopaedics
  • bone and joint infections
  • hip prosthesis implantation

Statistics from


  • Contributors Both authors were involved in the planning, conduct, reporting, conception and design and write up of the case report. CDB submitted the case report after review from the senior author JJJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.