Ramczykowski Tim, Kruppa Christiane, Schildhauer Thomas Armin, Dudda Marcel
Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
Department of Trauma Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
Arch Orthop Trauma Surg. 2018 Oct;138(10):1353-1358. doi: 10.1007/s00402-018-2980-3. Epub 2018 Jun 19.
The role of illicit drug abuse in total joint arthroplasty is largely unknown and is likely underestimated. Patients with drug addictions often suffer from septic osteoarthritis or a necrosis of the femoral head. Purpose of the study was to evaluate the operative management and clinical outcome of total hip replacement in patients with a history of intravenous drug abuse.
This retrospective study included 15 patients with a history of intravenous drug abuse who underwent total hip arthroplasty. A total of 6 females and 9 males with an average age of 34.3 years were identified. Ten patients presented an acute bacterial coxitis (Coxitis-group) and five an aseptic osteonecrosis of the femoral head (Osteonecrosis-group).
Ten patients with a bacterial coxitis underwent a two-staged total hip arthroplasty (THA), with temporary insertion of a drug-eluting spacer. Five patients with a necrosis of the femoral head were primarily treated with THA. All patients developed multiple re-infections after insertion of a drug-eluting spacer or THA. Only two patients finally achieved a THA without infection in the period of 3.9 years follow-up. The other 13 patients underwent a Girdlestone arthroplasty (7 patients) or total joint replacement with a chronic fistula (6 patients).
THA in patients with illicit drug abuse shows a low success rate. Following septic osteoarthritis or osteonecrosis in drug-addicted patients, we recommend a two-stage procedure with temporary insertion of a drug-eluting spacer. THA might follow only under strict premises.
非法药物滥用在全关节置换术中的作用很大程度上未知，且可能被低估。吸毒成瘾的患者常患有化脓性骨关节炎或股骨头坏死。本研究的目的是评估有静脉药物滥用史的患者行全髋关节置换术的手术管理及临床结果。
这项回顾性研究纳入了15例有静脉药物滥用史且接受了全髋关节置换术的患者。共确定了6名女性和9名男性，平均年龄为34.3岁。10例患者表现为急性细菌性髋关节炎（髋关节炎组），5例为股骨头无菌性坏死（骨坏死组）。
10例细菌性髋关节炎患者接受了两阶段全髋关节置换术（THA），临时植入药物洗脱间隔物。5例股骨头坏死患者主要接受THA治疗。所有患者在植入药物洗脱间隔物或THA后均发生多次再感染。在3.9年的随访期内，只有2例患者最终成功进行了无感染的THA。其他13例患者接受了Girdlestone关节成形术（7例）或伴有慢性瘘管的全关节置换术（6例）。
有非法药物滥用史的患者行THA成功率较低。在吸毒成瘾患者发生化脓性骨关节炎或骨坏死之后，我们建议采用临时植入药物洗脱间隔物的两阶段手术。只有在严格的前提下才可能进行THA。
