Custom-Made Cement Spacer to Replace a PIP-Infected Prosthesis: A Case Report and Review of Therapeutic Options

Background: Use of a prosthesis to replace small hand joints, mainly in patients with degenerative osteoarthritis or with sequelae of fractures, is more and more common. As for other joints, use of a prosthesis usually leads to good functional results but is not free of complications such as implant infection. We discuss a possible solution by presenting a single case treated by means of a custom-made spacer in our hospital and comparing it to the very few options available in the literature. Methods: A 30-year-old active male, treated in another hospital two years before for an articular fracture of the middle phalanx of the ring finger of his left hand, came to our center with a rigid digit. He was therefore treated with a Swanson proximal interphalangeal (PIP) joint prosthesis. At one-month follow-up, the patient presented clear signs of infection of his implant. The authors removed the infected implant and replaced it with a small custom-made antibiotic-impregnated cement spacer. The patient underwent a long-lasting postoperative oral antibiotic therapy. Four months later, a new Swanson prosthesis was successfully implanted. A literature review was performed. Results: When the patient first came to our hospital, he presented with a rigid digit, reaching a PIP joint range of motion (ROM) in flexion–extension of 0–90° the day after our first surgery. At one-month follow-up, with the infected prosthesis, the ROM was 10–40°. After the last surgery, with the implant of a new Swanson prosthesis, at the two-year (24-month) follow-up, the patient was infection-free, the PIP joint ROM was 10–90°, and the patient was very satisfied. Conclusions: The literature discusses few cases of PIP prosthesis infection, and most of those are treated with implant removal and arthrodesis. The use of a custom-made antibiotic-loaded cement spacer should be considered by hand surgeons managing this complication as a motion-preserving alternative to more definitive salvage procedures.