Fink Bernd, Grossmann Alexandra, Fuerst Martin, Schäfer Peter, Frommelt Lars
Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
Clin Orthop Relat Res. 2009 Jul;467(7):1848-58. doi: 10.1007/s11999-008-0611-y. Epub 2008 Nov 11.
Cementless two-stage revision of infected total hip prostheses lacks the possibility of local antibiotic protection of the implant at the time of reimplantation, which leads to the concern that this protocol may not sufficiently eradicate periprosthetic infection. Moreover, early implant loosening as much as 18% and stem subsidence as much as 30% have been reported. To determine whether a cementless revision could eradicate infection and achieve sufficient implant stability, we prospectively followed 36 patients with two-stage revisions for septic hip prostheses. We used a uniform protocol of a 6-week spacer interval, specific local and systemic antibiotic therapies, and cementless modular revision stems. The minimum followup was 24 months (mean, 35 months; range, 24-60 months). In one patient, the spacer was changed when the C-reactive protein value failed to normalize after 6 weeks, and the reimplantation was performed after an additional 6 weeks. No infections recurred. There was no implant loosening and a 94% bone-ingrowth fixation of stems. Subsidence occurred in two patients. The Harris hip score increased from a preoperative mean of 41 to 90 at 12 months after reimplantation and later. Using cementless prostheses in two-stage revisions of periprosthetic infections of the hip in combination with a specific local and systemic antibiotic therapy seems to eradicate infection and provide implant stability.
Level IV, therapeutic study.
感染性全髋关节假体的非骨水泥型两阶段翻修术在再次植入时缺乏对植入物进行局部抗生素保护的可能性，这引发了人们对该方案可能无法充分根除假体周围感染的担忧。此外，据报道早期植入物松动率高达18%，柄部下沉率高达30%。为了确定非骨水泥型翻修术能否根除感染并实现足够的植入物稳定性，我们对36例接受感染性髋关节假体两阶段翻修术的患者进行了前瞻性随访。我们采用了统一的方案，包括6周的间隔器置入期、特定的局部和全身抗生素治疗以及非骨水泥型模块化翻修柄。最短随访时间为24个月（平均35个月；范围24 - 60个月）。1例患者在6周后C反应蛋白值未恢复正常时更换了间隔器，并在额外6周后进行了再次植入。无感染复发。无植入物松动，柄部骨长入固定率为94%。2例患者出现下沉。Harris髋关节评分从术前平均41分提高到再次植入后12个月及以后的90分。在髋关节假体周围感染的两阶段翻修术中使用非骨水泥型假体，并结合特定的局部和全身抗生素治疗，似乎可以根除感染并提供植入物稳定性。
IV级，治疗性研究。
