Kamath Atul F, Austin Daniel, Lee Gwo-Chin
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
J Orthop Surg (Hong Kong). 2012 Aug;20(2):263-8. doi: 10.1177/230949901202000228.
Reconstruction for concurrent infection of an ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is a challenge. We report a 2-stage reconstruction of a THA for chronic infection of both the THA and TKA with severe femoral bone loss secondary to interprosthetic fractures. The reconstruction involved using a custom-made, temporary, antibiotic-impregnated PROSTALAC spacer mated with an intramedullary nail. The acetabulum was then exposed and the necrotic cartilage was removed and curetted. The acetabulum was reamed to accept a PROSTALAC acetabular shell. The shell was cemented into the acetabulum with antibiotic cement. The custom-made spacer was then inserted distally first into the tibia. The distal end of the intramedullary nail was interlocked with a bicortical bolt to minimise nail rotation. Antibiotic-impregnated cement was moulded around the nail and spacer. The proximal end of the spacer was then reduced into the acetabular socket, and the joint was irrigated and the wound closed. A customised abduction brace was fitted, and partial weight bearing was allowed. Sufficient leg length, soft-tissue tension, and range of hip motion were restored, and a total femur and constrained liner was re-implanted 4 months later. Mating of an intramedullary nail with a PROSTALAC spacer is a viable reconstructive option.
同侧全髋关节置换术（THA）和全膝关节置换术（TKA）并发感染的重建是一项挑战。我们报告了一例因假体间骨折继发严重股骨骨丢失而导致THA和TKA慢性感染的THA两阶段重建病例。重建过程包括使用定制的、临时的、含抗生素的PROSTALAC间隔物与髓内钉配合使用。然后暴露髋臼，去除坏死软骨并刮除。髋臼扩髓以容纳PROSTALAC髋臼杯。将髋臼杯用抗生素骨水泥固定于髋臼。然后将定制间隔物首先向远端插入胫骨。髓内钉远端用双皮质螺栓锁定以尽量减少钉的旋转。在钉和间隔物周围浇铸含抗生素骨水泥。然后将间隔物近端复位至髋臼窝，冲洗关节并关闭伤口。安装定制的外展支具，允许部分负重。恢复了足够的下肢长度、软组织张力和髋关节活动范围，4个月后重新植入全股骨和限制性衬垫。髓内钉与PROSTALAC间隔物配合是一种可行的重建选择。
