Pietsch Martin, Hofmann Siegfried, Wenisch Christian
Allgemeines und orthopädisches Landeskrankenhaus, Stolzalpe, Osterreich.
Oper Orthop Traumatol. 2006 Mar;18(1):66-87. doi: 10.1007/s00064-006-1163-5.
Treatment of deep infection of total knee arthroplasty by two-stage reimplantation. Using an articulating spacer may reduce the disadvantages of a static spacer (ligament contracture, muscle atrophy, muscle contraction, arthrofibrosis, and bone loss). Restoration of pain-free loading and ability to walk.
Late deep infection after total knee arthroplasty.
infection occurring at least 6 weeks after the initial arthroplasty.
Large metaphyseal bony defects of the distal femur and proximal tibia. Missing or insufficient extensor mechanism.
The articulating spacer is made intraoperatively by cleaning and autoclaving the explanted femoral component and the tibial polyethylene insert. These components are reinserted by "press-fit cementing" without cement interdigitation into the trabecular bone. The cement is loaded with antibiotic during the same operation (2-4 g antibiotics per 40 g of cement powder).
With the articulating spacer in place, partial weight bearing with crutches and continuous passive motion daily up to a flexion of 90 degrees are allowed. Usually, reimplantation with a standard revision system is scheduled for 6-12 weeks after spacer implantation.
In a prospective study 33 consecutive patients were treated from February 2000 to July 2003. The average period of hospitalization after spacer implantation was 14 days (8-26 days). Three patients had recurrent infection (success rate 91%) after a mean follow-up period of 28 months (12-48 months). The average Hospital for Special Surgery Knee Score could be increased from 67 points (44-84 points) preoperatively to 87 points (53-97 points) after reimplantation. The complications were one temporary peroneal palsy, one dislocation of the spacer due to the absence of the extensor ligaments, and one fracture of the tibia due to substantial primary metaphyseal bone loss.
采用两阶段再植入术治疗全膝关节置换术后深部感染。使用活动间隔物可减少静态间隔物的缺点（韧带挛缩、肌肉萎缩、肌肉收缩、关节纤维性变和骨质丢失）。恢复无痛负重及行走能力。
全膝关节置换术后晚期深部感染。
初次关节置换术后至少6周发生的感染。
股骨远端和胫骨近端大的干骺端骨缺损。伸肌机制缺失或不足。
活动间隔物在术中通过对外植的股骨部件和胫骨聚乙烯内衬进行清理及高压灭菌制成。这些部件通过“压入式骨水泥固定”重新植入，骨水泥不与小梁骨相互交错。在同一手术中骨水泥中加入抗生素（每40克骨水泥粉末加入2 - 4克抗生素）。
放置活动间隔物后，允许使用拐杖部分负重，并每天进行持续被动活动，直至屈曲达90度。通常，在间隔物植入后6 - 12周安排使用标准翻修系统进行再植入。
在一项前瞻性研究中，2000年2月至2003年7月连续治疗了33例患者。间隔物植入后的平均住院时间为14天（8 - 26天）。平均随访28个月（12 - 48个月）后，3例患者出现复发性感染（成功率91%）。特殊外科医院膝关节平均评分可从术前的67分（44 - 84分）提高到再植入后的87分（53 - 97分）。并发症包括1例暂时性腓总神经麻痹、1例因伸肌韧带缺失导致的间隔物脱位以及1例因严重的原发性干骺端骨质丢失导致的胫骨骨折。
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