One and a half-stage Total Hip Arthroplasty with Custom-Made Articulating Spacers (CUMARS) for Management of Bilateral Destructive Hip Septic Arthritis – A Case Report

Septic arthritis (SA) is a rare but potentially debilitating condition that can have quality-of-life impacting consequences. Prompt diagnosis and management is pivotal for early infection eradication and prevention of severe joint destruction. However, in a severely destructed joint, surgical options include resection arthroplasty or total hip arthroplasty (THA). Two-stage THA has been described in native hip SA with joint destruction while 1.5-stage THA has only been described in infected THA. This led to the consideration of 1.5-stage THA for management of chronic destructive hip SA. We report a 67-year-old patient with functional decline over eight months. Work-up revealed raised inflammatory markers and bilateral destructive hip SA. He underwent bilateral 1.5-stage THA with antibiotic-loaded Custom-Made Articulating Spacers (CUMARS). Post-operatively, he remains infection free is progressing well with rehabilitation. Management of SA varies largely depending on infection duration, activity level and extent of joint destruction. In primary destructive hip SA, a 1.5-stage THA with CUMARS can be considered due to the benefits of effective infection eradication, cost-effectiveness with reduced physical and psychological burden in avoiding a second operation, yet not precluding the possibility of a two-stage exchange THA if required.