Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2017 Nov;32(11):3510-3518. doi: 10.1016/j.arth.2017.05.053. Epub 2017 Jun 8.
Prolonged retention of an antibiotic spacer is occasionally chosen during treatment of periprosthetic joint infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of our study was to evaluate the outcome of extended spacer retention.
We reviewed 1106 cases of periprosthetic joint infection after THA (n = 308) and TKA (n = 798) and identified 17 (5.5%) retained hip and 34 (4.3%) retained knee spacers. Most patients (35 of 51, 69%) underwent spacer retention because they were medically unfit for further surgery. The remaining patients (16 of 51, 31%) had acceptable function and forewent further surgery. Competing risk analyses, with death as the competing risk, determined the cumulative incidence of reinfection and spacer revision. Radiographic analysis and clinical outcomes were analyzed.
The 2-year cumulative incidence for reinfection was 7% for retained hip and 13% for retained knee spacers. The cumulative incidence for all-cause spacer revision was 28% at 4 years for hips and 21% at 2 years for knees. The most common complications were implant migration and femoral spacer subsidence in the hip cohort, and supracondylar femur fractures and spacer dislocations in the knee cohort. The cumulative incidence for radiographic signs of mechanical failure was 72% and 87% at late follow-up for the hip and knee groups, respectively. The latest Harris Hip Score and Knee Society Score were 62 and 63, respectively.
Antibiotic spacer retention is a rare event in the course of planned 2-stage treatment of infected THA or TKA. Failure secondary to recurrent infection is uncommon; however, failure for mechanical reasons is frequent and clinical outcomes are relatively poor.
在全髋关节置换术（THA）和全膝关节置换术（TKA）后治疗假体周围关节感染时，偶尔会选择延长抗生素间隔器的保留时间。我们研究的目的是评估延长间隔器保留时间的结果。
我们回顾了 1106 例 THA（n=308）和 TKA（n=798）后假体周围关节感染的病例，确定了 17 例髋关节（5.5%）和 34 例膝关节（4.3%）保留的间隔器。大多数患者（51 例中的 35 例，69%）因身体状况不适合进一步手术而保留间隔器。其余患者（51 例中的 16 例，31%）功能可接受，因此未进行进一步手术。以死亡为竞争风险，进行竞争风险分析，以确定再感染和间隔器翻修的累积发生率。分析影像学分析和临床结果。
保留髋关节的 2 年再感染累积发生率为 7%，保留膝关节的为 13%。4 年时髋关节的全因间隔器翻修累积发生率为 28%，2 年时膝关节的为 21%。最常见的并发症是髋关节组中的植入物迁移和股骨间隔器下沉，以及膝关节组中的股骨髁上骨折和间隔器脱位。髋关节组的影像学机械失败迹象的累积发生率为 72%，膝关节组为 87%。最新的 Harris 髋关节评分和膝关节协会评分分别为 62 和 63。
在计划的 2 期治疗感染性 THA 或 TKA 的过程中，抗生素间隔器保留是一种罕见的情况。继发于再感染的失败并不常见；然而，由于机械原因导致的失败很常见，临床结果相对较差。
