Kraay Matthew J, Goldberg Victor M, Fitzgerald Steven J, Salata Michael J
Department of Orthopaedic Surgery, University Hospitals of Cleveland and the Case Western Reserve University, Cleveland, OH 44106, USA.
Clin Orthop Relat Res. 2005 Dec;441:243-9. doi: 10.1097/01.blo.0000194312.97098.0a.
bTwo-staged exchange with delayed reimplantation of a new prosthesis is considered by many to be the preferred method of treatment for deep periprosthetic infection after total hip arthroplasty. Until recently, most authors of previously published reports of this two-staged exchange procedure have used cemented implants fixed with antibiotic-containing bone cement. In view of the superior results of revision total hip arthroplasties with cementless implants, we reviewed the results of 33 two-staged revision total hip arthroplasties done for deep infection using cementless femoral components. There were no recurrent infections in the 28 patients in this study who had a 2-year minimum followup. Two patients developed a new infection with a different organism after reimplantation of their hip. Three patients with considerable acetabular bone deficiency had acetabular component revision for aseptic loosening; however, there were no cases of femoral component loosening. The overall infection rate of 7% using this approach was comparable to previous reports of two-staged revision total hip arthroplasties done with cemented components fixed with antibiotic-containing bone cement. In addition, cementless femoral component fixation seemed to be more reliable and durable in comparison to previous reports of revision total hip arthroplasty with cemented stems. The results of this study support the continued use of cementless implant fixation for two-staged reconstruction of the infected total hip arthroplasty.
Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.
许多人认为，两阶段翻修并延迟重新植入新假体是全髋关节置换术后深部假体周围感染的首选治疗方法。直到最近，此前发表的关于这种两阶段翻修手术的大多数报告的作者都使用含抗生素骨水泥固定的骨水泥型植入物。鉴于非骨水泥型植入物在翻修全髋关节置换术中取得了更好的效果，我们回顾了33例使用非骨水泥型股骨组件进行深部感染两阶段翻修全髋关节置换术的结果。本研究中28例患者至少随访2年，均无感染复发。两名患者在髋关节重新植入后出现了由不同病原体引起的新感染。三名髋臼骨量严重不足的患者因无菌性松动接受了髋臼组件翻修；然而，没有股骨组件松动的病例。采用这种方法的总体感染率为7%，与此前关于使用含抗生素骨水泥固定的骨水泥型组件进行两阶段翻修全髋关节置换术的报告相当。此外，与此前关于使用骨水泥柄进行翻修全髋关节置换术的报告相比，非骨水泥型股骨组件固定似乎更可靠、更耐用。本研究结果支持在感染性全髋关节置换术的两阶段重建中继续使用非骨水泥型植入物固定。
治疗性研究，IV-1级（病例系列）。有关证据水平的完整描述，请参见作者指南。
