Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
Clin Orthop Relat Res. 2011 Apr;469(4):994-1001. doi: 10.1007/s11999-010-1644-6.
Chronic infections in TKA have been traditionally treated with a two-stage protocol incorporating a temporary antibiotic-loaded cement spacer. The use of a static as opposed to an articulating spacer is controversial. Some surgeons believe a static spacer results in a higher rate of infection eradication, whereas others believe an articulating spacer provides equivalent rates of infection control with improved function between stages and the potential for better eventual range of motion.
QUESTIONS/PURPOSES: We determined the rates of infection control and postoperative function for an articulating all-cement antibiotic spacer fashioned intraoperatively from prefabricated silicone molds.
We retrospectively reviewed 60 patients with an infected TKA using the same cement-on-cement articulating spacer. A minimum of 4 g antibiotic per package of cement was used when making the spacer. Complications and pre- and postoperative knee flexion, extension, and Knee Society scores were recorded. Bone loss associated with the spacer was determined radiographically and by intraoperative inspection of the bony surfaces at the second stage. Minimum followup was 24 months (mean, 35 months; range, 24-51 months).
Seven patients (12%) became reinfected, four with an organism different from that identified at the index resection arthroplasty. One spacer femoral component broke between stages but did not require any specific treatment. We identified no bone loss between stages and no complications related to the cement-on-cement articulation. The mean pretreatment Knee Society scores of 53 improved to 79. The mean preoperative flexion of 90.6º improved to 101.3º at final followup.
An articulating antibiotic spacer was associated with control of a deep periprosthetic infection in 88% of patients while allowing range of motion between stages.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
慢性感染的 TKA 一直以来都采用两阶段方案治疗，其中包括一个临时载抗生素的水泥间隔器。使用固定而不是活动间隔器存在争议。一些外科医生认为固定间隔器会提高感染清除率，而另一些则认为活动间隔器在两个阶段之间提供了相同的感染控制率，并且具有更好的功能和最终更大的活动范围的潜力。
问题/目的：我们确定了使用预制硅胶模具术中制作的活动全水泥抗生素间隔器控制感染和术后功能的比率。
我们回顾性分析了 60 例感染性 TKA 使用相同的水泥对水泥活动间隔器的患者。制作间隔器时，每包水泥使用至少 4 克抗生素。记录并发症以及术前和术后膝关节的屈曲、伸展和膝关节协会评分。通过放射学和第二期手术时对骨表面的术中检查确定与间隔器相关的骨丢失。最低随访时间为 24 个月（平均 35 个月；范围 24-51 个月）。
7 例（12%）患者再次感染，其中 4 例感染的病原体与索引切除关节成形术时的不同。一个间隔器股骨组件在两个阶段之间断裂，但不需要任何特殊治疗。我们没有发现两个阶段之间的骨丢失，也没有与水泥对水泥关节相关的并发症。术前膝关节协会评分从 53 分提高到 79 分。术前平均屈曲度从 90.6°提高到最终随访时的 101.3°。
活动抗生素间隔器在 88%的患者中控制了深部假体周围感染，同时允许两个阶段之间的活动范围。
四级，治疗研究。有关证据水平的完整描述，请参阅作者指南。
