Marczak Dariusz, Synder Marek, Sibiński Marcin, Polguj Michał, Dudka Julian, Kowalczewski Jacek
Orthopaedic Department, Postgraduate Medical Education Center, Otwock ul. Konarskiego 13, 05-400, Otwock, Poland.
Department of Orthopaedics and Pediatric Orthopaedics, Medical University of Lodz, ul. Pomorska 251, 92-213, Łódź, Poland.
Int Orthop. 2017 Nov;41(11):2253-2258. doi: 10.1007/s00264-017-3500-8. Epub 2017 May 18.
The aim of this study was to compare two methods of two-stage surgery for PJI (periprosthetic joint infection) after THA (total hip arthroplasty): one with and one without the use of an antibiotic-loaded cement spacer.
This retrospective study was performed on 99 consecutive patients (99 hips) with a minimum follow-up of 24 months. Patients were divided into two groups: (1) in whom the operation was performed using a spacer, and (2) for whom a spacer was not used.
For the whole cohort, the results improved between pre-operative and final follow-up. Recurrence of infection was found in nine out of 98 patients (9.2%) and was not significantly different between the two groups. Patients treated with a spacer had better functional improvement in the interim period, but the VAS score was better in the non-spacer group. The improvement in final function was better in the spacer group with regard to HHS, but not according to WOMAC score or VAS at final follow-up.
The resection arthroplasty should be awarded particular consideration in cases of poor soft tissue quality, bone stock deficiency, when complications related to spacer use are expected or chances of new hip endoprosthesis implantation are low.
本研究旨在比较全髋关节置换术（THA）后假体周围关节感染（PJI）的两种两阶段手术方法：一种使用含抗生素的骨水泥间隔物，另一种不使用。
本回顾性研究对99例连续患者（99髋）进行，最短随访24个月。患者分为两组：（1）使用间隔物进行手术的患者，（2）未使用间隔物的患者。
对于整个队列，术前和最终随访之间结果有所改善。98例患者中有9例（9.2%）出现感染复发，两组之间无显著差异。使用间隔物治疗的患者在过渡期功能改善更好，但非间隔物组的视觉模拟评分（VAS）更好。在最终随访时，间隔物组在髋关节 Harris 评分（HHS）方面最终功能改善更好，但根据 Western Ontario and McMaster Universities 骨关节炎指数（WOMAC）评分或 VAS 并非如此。
在软组织质量差、骨量不足、预期会出现与使用间隔物相关的并发症或新髋关节假体植入机会低的情况下，应特别考虑行切除关节成形术。
