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Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections

Michele Fiore|Claudia Rondinella|Azzurra Paolucci|Lorenzo Morante|Massimiliano De Paolis|Andrea Sambri
대한고관절학회 (The Korean Hip Society)|2023.03|Hip and Pelvis|제35권 제1호|pp. 32-39|DOI https://doi.org/10.5371/hp.2023.35.1.32

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키워드

HipTwo-stageProsthetic joint infectionsCement spacersPolymethilmetacrilate

초록

Purpose: A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the “gold standard” for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer. Materials and Methods: A retrospective review of 64 consecutive patients was conducted: 34 underwent twostage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays. Results: Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9;P<0.001). Conclusion: The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure.

Abstract

Purpose: A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the “gold standard” for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer. Materials and Methods: A retrospective review of 64 consecutive patients was conducted: 34 underwent twostage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays. Results: Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9;P<0.001). Conclusion: The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure.

참고문헌 (38)

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관련 논문AI추천

Staged Revision of Infected-hip Arthroplasty Using an Antibiotics-loaded Intra-articular Cement Spacer: Impact on Cemented and Cementless Stem Retention성열보, Byung-Ho Yoon, Joong-Won Lee, Kyu-Sub Um대한고관절학회 · Hip and Pelvis2020 · 제32권 제1호Reducing Dislocations of Antibiotic Hip Spacers via Hybrid Cement-screw Constrained Liner Fixation: A Case SeriesAnthony Viola, David M. Keller, Frank A. Liporace, Jay N. Patel, Richard A. Pizzo, Richard S. Yoon대한고관절학회 · Hip and Pelvis2020 · 제32권 제4호Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis김인성, 유제현, 이상수, 장준동대한고관절학회 · Hip and Pelvis2017 · 제29권 제1호Management of Periprosthetic Hip Joint Infection손원용, 이희동, Kumar Prashant대한고관절학회 · Hip and Pelvis2015 · 제27권 제2호Clinical outcomes of two-stage revision total knee arthroplasty in infected cases with antibiotic-loaded cement spacers produced using a handmade silicone moldHoshino Takashi, Katagiri Hiroki, Koga Hideyuki, Kono Yuji, Nakagawa Yusuke, Ohara Toshiyuki, Ozeki Nobutake, Sekiya Ichiro, Shioda Mikio, Watanabe Toshifumi대한슬관절학회 · Knee Surgery and Related Research2021 · 제33권 Efficacy of Debridement for Early Periprosthetic Joint Infection after Hip Arthroplasty김종훈, 손원용, 윤용철, 천성광, Devendra Lakhotia대한고관절학회 · Hip and Pelvis2014 · 제26권 제4호

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