Departments of Orthopedics and Traumatology, Ospedale Papa Giovanni XXIII via OMS1, Bergamo, 24100, Italy.
Int Orthop. 2014 Feb;38(2):405-12. doi: 10.1007/s00264-013-2241-6. Epub 2014 Jan 26.
Infection following knee replacement is an important cause of failure despite rigorous prophylaxis antibiotic protocols. The two-stage reimplantation procedure is considered the gold standard for treatment of subacute and chronic deep periprosthetic infections. The purpose of this study was to determine whether or not a preformed articulated spacer would allow comparable eradication of infection equal to rates reported in published studies and to see whether there is a resulting improvement in postoperative function with an acceptable quality of life, reducing postoperative pain and limiting surgical complications, thus simplifying the second stage of the procedure.
We retrospectively reviewed 50 patients with infected TKA who underwent a two-stage exchange arthroplasty using an articulating preformed spacer. The device, designed like an ultracongruent condylar knee prosthesis, is composed of acrylic cement impregnated with antibiotic, with tested and standardised mechanical properties and antibiotic content and release mechanism.
The median follow-up period was seven (two to 13) years. Two-stage exchange arthroplasty was successful in controlling the infection in 92% of patients; 64% of patients where women, and median patient age was 68 (54-80) years. Median implantation time of the preformed spacer was 16 (four to 60) weeks; 4% of infections were delayed, and 96% were late. Forty-six percent were caused by coagulase-negative Staphylococcus (CoNS). Mean Knee Society Score (KSS) was 35.38 (clinical) and 37.96 (function) on presentation; it improved to a mean of 72.92 (clinical) and 76.04 (function) after the first stage and to a mean of 75.38 (clinical) and 80.58 (function) at the final review. Bone loss was unchanged between stages, and range of motion remained unchanged or improved after definitive reimplantation.
The use of preformed articulated knee spacer during a two stage technique for infected TKA improves patient QOL between stages and increases patient compliance and cooperation, reducing social costs.
尽管采用了严格的预防抗生素方案，但膝关节置换术后感染仍然是导致失败的一个重要原因。两阶段再植入手术被认为是治疗亚急性和慢性深部假体周围感染的金标准。本研究的目的是确定预制关节成形 spacer 是否能够以与已发表研究报告的比率相当的方式根除感染，并观察术后功能是否有所改善，同时具有可接受的生活质量，减轻术后疼痛并限制手术并发症，从而简化手术的第二阶段。
我们回顾性分析了 50 例接受两阶段置换关节成形术治疗感染性 TKA 的患者，使用了关节预制 spacer。该设备的设计类似于超关节髁膝关节假体，由含抗生素的丙烯酸水泥制成，具有经过测试和标准化的机械性能以及抗生素含量和释放机制。
中位随访时间为 7 年（2-13 年）。两阶段置换关节成形术成功控制了 92%的患者的感染；64%的患者为女性，中位患者年龄为 68 岁（54-80 岁）。预制 spacer 的中位植入时间为 16 周（4-60 周）；4%的感染为延迟性感染，96%为晚期感染。46%的感染由凝固酶阴性葡萄球菌（CoNS）引起。初次就诊时，膝关节协会评分（KSS）的平均值为 35.38（临床）和 37.96（功能）；在第一阶段后，它提高到平均 72.92（临床）和 76.04（功能），在最终随访时提高到平均 75.38（临床）和 80.58（功能）。两阶段之间骨丢失无变化，在最终再植入后，活动范围保持不变或改善。
在两阶段技术治疗感染性 TKA 期间使用预制关节成形 spacer 可提高患者在两阶段之间的生活质量，并提高患者的依从性和合作性，降低社会成本。
