Chen Kun-Hui, Tsai Shang-Wen, Wu Po-Kuei, Chen Cheng-Fong, Wang Hsin-Yi, Chen Wei-Ming
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No 201, Sec 2, Shipai Rd, Beitou District, Taipei, Taiwan, 11217, Republic of China.
Department of Surgery, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou District, Taipei, Taiwan, 11217, Republic of China.
Int Orthop. 2017 Dec;41(12):2479-2486. doi: 10.1007/s00264-017-3505-3. Epub 2017 May 27.
Two-stage reconstruction with total implant removal and re-implantation after infection control is considered the gold standard treatment for infection after hip arthroplasty. However, removal of the well-fixed stem or cup may cause substantial bone loss and other complications, thereby making reconstruction difficult. We evaluated whether an infection post total hip arthroplasty can be treated without removal of the radiographically and clinically well-fixed femoral stem or acetabular cup.
Patients with a chronic infection after total hip arthroplasty, with a radiographically well-fixed, cementless stem or cup, were selected. During the first surgical stage, we retained the stem or cup if we were unable to remove these with a stem or cup extractor. An antibiotic-impregnated cement spacer was then implanted. After control of infection (C-reactive protein level within normal value), we performed the second stage of re-implantation surgery. Treatment failure was defined as uncontrolled infection requiring removal of the retained implant.
From January 2004 to December 2013, 16 patients underwent partial component-retained two stage reconstruction. Thirteen patients (81.3%) were free of infection, with a mean follow-up time of five years. The remaining three patients, who had high-risk comorbidities and, of whom, two were infected by high-virulence organisms, had uncontrolled infection and required further surgery to remove the retained implant.
Partial component-retained two-stage reconstruction could be an alternative treatment option for chronic infection after an uncemented total hip arthroplasty with a radiographically and clinically well-fixed component in selected patients, who are not immunocompromised and are infected by a low-virulence organism.
在感染得到控制后进行全植入物取出并重新植入的两阶段重建被认为是髋关节置换术后感染的金标准治疗方法。然而，取出固定良好的股骨柄或髋臼杯可能会导致大量骨质流失和其他并发症，从而使重建变得困难。我们评估了全髋关节置换术后的感染是否可以在不取出影像学和临床上固定良好的股骨柄或髋臼杯的情况下进行治疗。
选择全髋关节置换术后发生慢性感染且影像学上股骨柄或髋臼杯固定良好的非骨水泥型患者。在第一阶段手术中，如果我们无法用股骨柄或髋臼杯取出器取出这些植入物，我们就保留股骨柄或髋臼杯。然后植入抗生素骨水泥间隔物。在感染得到控制（C反应蛋白水平在正常范围内）后，我们进行第二阶段的重新植入手术。治疗失败定义为感染无法控制，需要取出保留的植入物。
从2004年1月到2013年12月，16例患者接受了部分组件保留的两阶段重建。13例患者（81.3%）无感染，平均随访时间为5年。其余3例患者有高危合并症，其中2例感染了高毒力微生物，感染无法控制，需要进一步手术取出保留的植入物。
对于非免疫功能低下且感染低毒力微生物、影像学和临床上组件固定良好的非骨水泥型全髋关节置换术后慢性感染患者，部分组件保留的两阶段重建可能是一种替代治疗选择。
