New Technique for Custom-Made Spacers in Septic Two-Stage Revision of Total Hip Arthroplasties

The choice of spacer in the interim phase of two-stage revision hip arthroplasty is crucial. Conventional concepts like a Girdlestone situation, handformed or preformed bone cement spacers show complications like soft-tissue contractions, abrasion of bone cement particles, dislocation, breakage and a low level of mobility in the interim phase. To address these disadvantages, the senior author developed a new technique for custom-made spacers in septic two-stage revision of total hip arthroplasties using prosthetic implants with individualized antibiotic mixture in the cement applying a mechanical inferior cementation method. The aim of this study was to evaluate the results of these spacers with respect to their non-inferiority in terms of reinfection and survival-rate of the new implant and to describe the complications associated with this procedure. Our collective consisted of 130 patients with a median follow-up of nearly five years. With a reinfect-free rate of 92% and a spacer-related complication rate of 10% (8% articular dislocation, 1% periprosthetic joint fracture, 1% breakage), this procedure seems to be safe and superior regarding complications compared to conventional concepts. Further studies are necessary to show the clinical benefit of this procedure.

Parties and the Party System of Israel

Both the parties and the party system of Israel have undergone significant changes during the last seventy years. This chapter begins by delineating the transformation of the political parties in Israel, from classic mass parties to a plethora of types that coexist somewhat uneasily, and from parties focused on domestic socioeconomic issues to ones dominated by foreign policy and security concerns. It then shifts to its main focus, assessing the changes in the party system. The chapter argues two points: first, that while the Israeli parties were extremely volatile, the party blocs were surprisingly stable; and second, that while the Israeli party system exhibited two very stable periods during the first fifty years—albeit with a short, transformative interim phase—during the last twenty-five years it has exhibited accelerated change and instability.

Parties and the Party System of Israel

Both the parties and the party system of Israel have undergone significant changes during the last seventy years. This chapter begins by delineating the transformation of the political parties in Israel, from classic mass parties to a plethora of types that coexist somewhat uneasily, and from parties focused on domestic socioeconomic issues to ones dominated by foreign policy and security concerns. It then shifts to its main focus, assessing the changes in the party system. The chapter argues two points: first, that while the Israeli parties were extremely volatile, the party blocs were surprisingly stable; and second, that while the Israeli party system exhibited two very stable periods during the first fifty years—albeit with a short, transformative interim phase—during the last twenty years it has exhibited accelerated change and instability.