Romanò Carlo L, Romanò Delia, Albisetti Alessandra, Meani Enzo
Centre for Reconstructive Surgery and Osteo-articular Infections, IRCCS Galeazzi Orthopaedic Institute, Milan - Italy.
Hip Int. 2012 Jul-Aug;22 Suppl 8:S46-53. doi: 10.5301/HIP.2012.9570.
Two-stage revision is the most widely accepted and performed intervention for chronically infected hip prosthesis and different interim spacers have been proposed. In recent years, antibiotic-loaded preformed spacers have become available on the market. The aim of this retrospective study was to assess the long-term results of two-stage revision with preformed spacers and uncemented hip prosthesis for the treatment of septic hip prosthesis. From 2000 to 2010, 183 consecutive patients underwent two-stage revision of septic hip prosthesis, with a same protocol, including preformed antibiotic-loaded cement spacer and a cementless modular hip revision prosthesis and four to six weeks antibiotic administration. Clinical and radiologic assessment at a minimum follow-up of two years was performed. At a minimum two years follow-up, 10 patients (5.4%) had had an infection recurrence, four (2.2%) an aseptic loosening and four more required partial revision of the modular components of the prosthesis, because of hip instability/dislocation; 21 patients died or were lost to follow-up. Considering all the reasons for revision, survivorship at eleven years was 93.9%. Harris Hip Score improved from 29.1 ± 14.6 pre-operatively to 41.1 ± 15.9 after spacer implant and 81.7 ± 17.6 after hip revision. The main complications after spacer implant included: spacer dislocation (16.4%), intra-operative femoral fractures (2.7%), and thromboembolism (2.1%). Complications after hip revision were: instability/dislocation (4,3%), intra-operative femoral fractures (1.6%), and thromboembolism (3.3%). Two-stage revision of septic hip prosthesis with preformed antibiotic-loaded spacers and cementless hip prosthesis provides satisfactory long-term results, with reduced complications.
两阶段翻修术是治疗慢性感染性髋关节假体最广泛接受和实施的干预措施，并且已经提出了不同的临时间隔物。近年来，预成型抗生素间隔物已在市场上有售。本回顾性研究的目的是评估使用预成型间隔物和非骨水泥型髋关节假体进行两阶段翻修术治疗感染性髋关节假体的长期效果。2000年至2010年，183例连续患者接受了感染性髋关节假体的两阶段翻修术，采用相同方案，包括预成型抗生素骨水泥间隔物和非骨水泥型模块化髋关节翻修假体，并进行四至六周的抗生素给药。进行了至少两年随访的临床和影像学评估。在至少两年的随访中，10例患者（5.4%）出现感染复发，4例（2.2%）出现无菌性松动，另外4例因髋关节不稳定/脱位需要对假体的模块化组件进行部分翻修；21例患者死亡或失访。考虑到所有翻修原因，11年时的生存率为93.9%。Harris髋关节评分从术前的29.1±14.6提高到植入间隔物后的41.1±15.9以及髋关节翻修后的81.7±17.6。植入间隔物后的主要并发症包括：间隔物脱位（16.4%）、术中股骨骨折（2.7%）和血栓栓塞（2.1%）。髋关节翻修后的并发症包括：不稳定/脱位（4.3%）、术中股骨骨折（1.6%）和血栓栓塞（3.3%）。使用预成型抗生素间隔物和非骨水泥型髋关节假体进行感染性髋关节假体的两阶段翻修术可提供令人满意的长期效果，并减少并发症。
