Staged Revision of Infected-hip Arthroplasty Using an Antibiotics-loaded Intra-articular Cement Spacer: Impact on Cemented and Cementless Stem Retention
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Currently, standard management of a peri-prosthetic infection is a two-stage revision precedure. However, removal of well-fixed cement is technically demanding and associated with numerous potential complications. For theses reasons, two-stage revision with preservation of the original femoral stem can be considered and several previous studies have achieved successful results. While most prior studies used cemented stems, the use of cementless stems during arthroplasty has been gradually increasing; this study aims to assess the comparative effectiveness of a two-stage revision of infected hip arthroplasties at preserving cemented and cementless stems. Materials and Methods: Between December 2001 and February 2017, Inje University Sanggye Paik Hospital treated 45 cases of deep infections following hip arthroplasty with a two stage revisional arthroplasty using antibiotics-loaded cement spacers. This approach was applied in an effort to preserve the previously implanted femoral stem. Of these 45 cases, 20 were followed-up for at least two years and included in this analysis. Perioperative clinical symptoms, radiological findings, function and complications during insertion of an antibioticsloaded cement spacer were analyzed in this study. Results: Peri-prothetic infections were controlled in 19 of the 20 included cases. Clinical outcomes, as assessed using the Harris hip score, Western Ontario and McMaster University score, also improved. Importantly, similarly improved outcomes were achieved for both cemented and cementless femoral stems. Conclusion: In cases of deep infection following hip arthroplasty, two-stage revision arthroplasty to preserve the previously implanted femoral stem (cemented or cementless) effectively controls infections and preserves joint function.
Abstract
Purpose: Currently, standard management of a peri-prosthetic infection is a two-stage revision precedure. However, removal of well-fixed cement is technically demanding and associated with numerous potential complications. For theses reasons, two-stage revision with preservation of the original femoral stem can be considered and several previous studies have achieved successful results. While most prior studies used cemented stems, the use of cementless stems during arthroplasty has been gradually increasing; this study aims to assess the comparative effectiveness of a two-stage revision of infected hip arthroplasties at preserving cemented and cementless stems. Materials and Methods: Between December 2001 and February 2017, Inje University Sanggye Paik Hospital treated 45 cases of deep infections following hip arthroplasty with a two stage revisional arthroplasty using antibiotics-loaded cement spacers. This approach was applied in an effort to preserve the previously implanted femoral stem. Of these 45 cases, 20 were followed-up for at least two years and included in this analysis. Perioperative clinical symptoms, radiological findings, function and complications during insertion of an antibioticsloaded cement spacer were analyzed in this study. Results: Peri-prothetic infections were controlled in 19 of the 20 included cases. Clinical outcomes, as assessed using the Harris hip score, Western Ontario and McMaster University score, also improved. Importantly, similarly improved outcomes were achieved for both cemented and cementless femoral stems. Conclusion: In cases of deep infection following hip arthroplasty, two-stage revision arthroplasty to preserve the previously implanted femoral stem (cemented or cementless) effectively controls infections and preserves joint function.
참고문헌 (34)
- Canner GC, "The infected hip after total hip arthroplasty", J Bone Joint Surg Am, 66, pp.1393~1399 (1984)
- Phillips JE, "The incidence of deep prosthetic infections in a specialist orthopaedic hospital : a 15-year prospective survey", J Bone Joint Surg Br, 88, pp.943~948 (2006)
- Volin SJ, "Two-stage reimplantation of total joint infections : a comparison of resistant and nonresistant organisms", Clin Orthop Relat Res, (427), pp.94~100 (2004)
- Toms AD, "The management of peri-prosthetic infection in total joint arthroplasty", J Bone Joint Surg Br, 88, pp.149~155 (2006)
- Paprosky WG, "Component removal in revision total hip arthroplasty", Clin Orthop Relat Res, (393), pp.181~193 (2001)
- Lord GA, "An uncemented total hip replacement : experimental study and review of 300 madreporique arthroplasties", Clin Orthop Relat Res, (141), pp.2~16 (1979)
- Morley JR, "Preservation of the original femoral cement mantle during the management of infected cemented total hip replacement by two-stage revision", J Bone Joint Surg Br, 94, pp.322~327 (2012)
- Ekpo TE, "Partial two-stage exchange for infected total hip arthroplasty : a preliminary report", Clin Orthop Relat Res, 472, pp.437~448 (2014)
- Schmidt J, "Removal of well-fixed or porous-coated cementless stems in total hip revision arthroplasty", Arch Orthop Trauma Surg, 122, pp.48~50 (2002)
- Lee YK, "Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty", Acta Orthop, 84, pp.260~264 (2013)
- 성열보, "대퇴 주대 보존 후 관절 내 항생제 혼합 시멘트 충전물을 이용한 인공 고관절 감염에 대한 단계적 재치환술", Hip and Pelvis, 22(1), pp.66~72 (2010), 대한고관절학회
- Chen KH, "Partial component-retained two-stage reconstruction for chronic infection after uncemented total hip arthroplasty : results of sixteen cases after five years of follow-up", Int Orthop, 41, pp.2479~2486 (2017)
- Parvizi J, "Definition of periprosthetic joint infection", J Arthroplasty, 29, pp.1331~ (2014)
- Spangehl MJ, "Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties", J Bone Joint Surg Am, 81, pp.672~683 (1999)
- Barrack RL, "Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review", J Bone Joint Surg Br, 74, pp.385~389 (1992)
- Harris WH, "Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation", J Bone Joint Surg Am, 51, pp.737~755 (1969)
- Bellamy N, "Validation study of WOMAC : a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee", J Rheumatol, 15, pp.1833~1840 (1988)
- Buchholz HW, "Management of deep infection of total hip replacement", J Bone Joint Surg Br, 63, pp.342~353 (1981)
- Callaghan JJ, "One-stage revision surgery of the infected hip. A minimum 10-year followup study", Clin Orthop Relat Res, (369), pp.139~143 (1999)
- Bittar ES, "Girdlestone arthroplasty for infected total hip arthroplasty", Clin Orthop Relat Res, (170), pp.83~87 (1982)
- Antti-Poika I, "Outcome of the infected hip arthroplasty. A retrospective study of 36 patients", Acta Orthop Scand, 60, pp.670~675 (1989)
- Balderston RA, "Treatment of the septic hip with total hip arthroplasty", Clin Orthop Relat Res, (221), pp.231~237 (1987)
- Lieberman JR, "Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol", Clin Orthop Relat Res, (301), pp.205~212 (1994)
- Salvati EA, "Reimplantation in infection : a 12-year experience", Clin Orthop Relat Res, (170), pp.62~75 (1982)
- Ivarsson I, "Revision of infected hip replacement. Two-stage procedure with a temporary gentamicin spacer", Acta Orthop Scand, 65, pp.7~8 (1994)
- Younger AS, "Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis", J Bone Joint Surg Am, 80, pp.60~69 (1998)
- Kendall RW, "Temporary antibiotic loaded acrylic hip replacement : a novel method for management of the infected THA", Semin Arthroplasty, 5, pp.171~177 (1994)
- Garvin KL, "Infection after total hip arthroplasty. Past, present, and future", J Bone Joint Surg Am, 77, pp.1576~1588 (1995)
- Sanchez-Sotelo J, "Midterm to long-term followup of staged reimplantation for infected hip arthroplasty", Clin Orthop Relat Res, 467, pp.219~224 (2009)
- English H, "Impaction grafting of the femur in two-stage revision for infected total hip replacement", J Bone Joint Surg Br, 84, pp.700~705 (2002)
- Cordero J, "Influence of bacterial strains on bone infection", J Orthop Res, 14, pp.663~667 (1996)
- Struhl S, "Infected uncemented hip arthroplasty. Preserving the femoral stem with a two-stage revision procedure", Orthop Rev, 18, pp.707~712 (1989)
- Yoon TR, "Treatment of infected uncemented total hip arthroplasty : two-stage revision procedure by preserving well-fixed femoral components in four cases", J Korean Orthop Assoc, 35, pp.467~472 (2000)
- Gristina AG, "Molecular mechanisms in musculoskeletal sepsis : the race for the surface", Instr Course Lect, 39, pp.471~482 (1990)