Stelwagen MH, Van Oldenrijk J, Croughs PD, Yusuf E, Bos PK, Veltman ES. Impact of introducing custom-made articulating spacers: A retrospective cohort study on two protocols for two-stage hip revision. World J Orthop 2025; 16(10): 111955 [DOI: 10.5312/wjo.v16.i10.111955]
Corresponding Author of This Article
Marijn H Stelwagen, MD, Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Center, Molewaterplein 40, Rotterdam 3015 GD, Netherlands. m.stelwagen@erasmusmc.nl
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Orthopedics
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 18, 2025 (publication date) through Oct 26, 2025
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World Journal of Orthopedics
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2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Stelwagen MH, Van Oldenrijk J, Croughs PD, Yusuf E, Bos PK, Veltman ES. Impact of introducing custom-made articulating spacers: A retrospective cohort study on two protocols for two-stage hip revision. World J Orthop 2025; 16(10): 111955 [DOI: 10.5312/wjo.v16.i10.111955]
World J Orthop. Oct 18, 2025; 16(10): 111955 Published online Oct 18, 2025. doi: 10.5312/wjo.v16.i10.111955
Impact of introducing custom-made articulating spacers: A retrospective cohort study on two protocols for two-stage hip revision
Marijn H Stelwagen, Jakob Van Oldenrijk, Peter D Croughs, Erlangga Yusuf, P Koen Bos, Ewout S Veltman
Marijn H Stelwagen, Jakob Van Oldenrijk, P Koen Bos, Ewout S Veltman, Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Center, Rotterdam 3015 GD, Netherlands
Peter D Croughs, Erlangga Yusuf, Department of Medical Microbiology, Erasmus Medical Center, Rotterdam 3015 GD, Netherlands
Author contributions: Veltman ES, Bos PK, Van Oldenrijk J and Stelwagen MH designed the study; Stelwagen MH collected the data and performed the statistical analysis, supervised by all authors; Stelwagen MH prepared the manuscript, all authors contributed to the draft and revision of the final manuscript.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and has been evaluated by the local review board. This type of study is exempt from medical ethics review under Dutch law (niet-WMO).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study. All data were fully anonymized prior to analysis.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marijn H Stelwagen, MD, Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Center, Molewaterplein 40, Rotterdam 3015 GD, Netherlands. m.stelwagen@erasmusmc.nl
Received: July 14, 2025 Revised: July 29, 2025 Accepted: September 9, 2025 Published online: October 18, 2025 Processing time: 94 Days and 13.9 Hours
Abstract
BACKGROUND
Two-stage revision is the most common treatment for chronic periprosthetic joint infection of the hip, involving a resection arthroplasty with or without placement of an antibiotic-loaded spacer, followed by antibiotic therapy before reimplantation.
AIM
To compare the outcomes and complications of two consecutive treatment protocols for two-stage revision arthroplasty of the infected hip: One using Girdlestone with an antibiotic holiday, the other using custom-made articulating spacers (CUMARS) without an antibiotic holiday.
METHODS
In this retrospective study, two consecutive cohorts were compared. Group A (2017-2020) underwent two-stage revision with a Girdlestone and an antibiotic holiday before reimplantation, while Group B (2020-2023) received CUMARS whenever possible, and no antibiotic holiday, or a Girdlestone if indicated. The primary outcome was successful infection eradication after one year. Secondary outcomes included surgical duration, length of hospital stay, weight-bearing allowance, discharge destination, and complications.
RESULTS
A total of 98 patients were included: 39 patients in Group A and 59 patients in Group B. Successful infection eradication after one year was achieved in 69% of Group A and 83% of Group B (P = 0.164). Patients in Group B were more frequently allowed to bear weight (64% vs 18%, P < 0.001), had a shorter in-hospital stay (9 vs 16 days, P < 0.001), and were more often discharged home after the first surgery (48% vs 24%, P = 0.048). No significant differences were found in (mechanical) complications.
CONCLUSION
A protocol including CUMARS is a safe and effective treatment, offering faster recovery, shorter length of hospital stay, and enabling more patients to return home during the interval. This reduces strain on patients and the healthcare system, potentially saving costs, without compromising infection control or increasing (mechanical) complications.
Core Tip: This retrospective cohort study compares two consecutive treatment protocols for two-stage hip revision in periprosthetic joint infection: One using only Girdlestone and another incorporating custom-made articulating spacers (CUMARS) whenever possible, or a Girdlestone when necessary. While infection eradication rates were similar, the introduction of CUMARS was associated with shorter hospital stays, earlier mobilization, and more frequent discharge to home. These results suggest that CUMARS facilitates a faster recovery for suitable patients and reduce healthcare burden without compromising infection control, making them a valuable addition to the treatment algorithm. For patients with contraindications, a Girdlestone remains a viable option.
