Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis VAMC Section 112E, 1 Veterans Drive, Minneapolis, MN 55417, USA.
Clin Orthop Relat Res. 2012 Jan;470(1):228-35. doi: 10.1007/s11999-011-2037-1.
Periprosthetic infection in TKA is a devastating and challenging problem for both patients and surgeons. Two-stage exchange arthroplasty with an interval antibiotic spacer reportedly has the highest infection control rate. Studies comparing static spacers with articulating spacers have reported varying ROM after reimplant, which could be due to differences in articulating spacer technique.
QUESTIONS/PURPOSES: We therefore determined whether one of three articulating spacer techniques was superior in terms of (1) infection control, (2) final ROM, and (3) cost.
We retrospectively reviewed 53 patients with infected TKAs who had two-stage exchange arthroplasty with one of three techniques with articulating spacers: autoclaving an original component (n = 15), a new femoral component (n = 16), and a silicone mold component (n = 22). We compared infection control, ROM, and cost. Minimum followup was 12 months (mean, 39 months; range, 12-105 months).
We found no difference in infection control among the three techniques. Infection control was achieved in 13 of 15 (86.7%) autoclaved original component spacers at mean 73 months (range, 37-105 months), 15 of 16 (93.8%) new femoral component spacers at mean 19 months (range, 12-32 months), and 20 of 22 (90.9%) silicone mold component spacers at mean 32 months (range, 14-56 months). Mean final flexion was 95.7°, 98.3°, and 93.8°, respectively. Direct costs for all implants, molds, cement, and antibiotics were $932, $3589, and $3945, respectively.
We found comparable infection control and ROM for the three techniques. Direct cost was least for the autoclaved original component technique.
TKA 中的假体周围感染对患者和外科医生来说都是一个具有破坏性和挑战性的问题。据报道，两阶段置换术联合抗生素间隔期 spacer 具有最高的感染控制率。比较静态 spacer 和活动 spacer 的研究报告了再植入后的不同 ROM，这可能是由于活动 spacer 技术的差异。
问题/目的：因此，我们确定了三种活动 spacer 技术中的一种在以下方面是否具有优势：（1）感染控制，（2）最终 ROM，和（3）成本。
我们回顾性分析了 53 例接受两阶段置换术联合使用三种活动 spacer 的感染 TKA 患者：（1）高压蒸汽灭菌原假体（n = 15），（2）新股骨假体（n = 16），和（3）硅模假体（n = 22）。我们比较了感染控制、ROM 和成本。最低随访时间为 12 个月（平均 39 个月；范围 12-105 个月）。
我们发现三种技术之间在感染控制方面没有差异。15 个高压蒸汽灭菌原假体 spacer 中有 13 个（86.7%）在平均 73 个月（范围 37-105 个月）时达到感染控制，16 个新股骨假体 spacer 中有 15 个（93.8%）在平均 19 个月（范围 12-32 个月）时达到感染控制，22 个硅模假体 spacer 中有 20 个（90.9%）在平均 32 个月（范围 14-56 个月）时达到感染控制。平均最终屈曲度分别为 95.7°、98.3°和 93.8°。所有植入物、模具、水泥和抗生素的直接成本分别为 932 美元、3589 美元和 3945 美元。
我们发现三种技术的感染控制和 ROM 相当。直接成本最低的是高压蒸汽灭菌原假体技术。
