Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, NY.
J Arthroplasty. 2019 Jun;34(6):1201-1206. doi: 10.1016/j.arth.2019.02.012. Epub 2019 Feb 15.
Antibiotic cement spacers are used during 2-stage revision total hip arthroplasty for prosthetic joint infection. Complications including dislocation and periprosthetic fracture have been reported but a large cohort comparing spacer design features is lacking. We aimed to determine if spacer design is associated with perioperative complications.
We performed a retrospective review of antibiotic cement spacers implanted between 2004 and 2014. Radiographic assessment included leg length, offset, and bone loss (Paprosky classification). Clinical outcomes included dislocation, periprosthetic fracture, spacer fracture, infection cure, and overall reoperation rate. Univariate analysis, Student's t-test, chi-squared test, or Kruskal-Wallis test was employed (P < .05).
One hundred eighty-five patients were treated: 42% were female and mean age was 64 years (range 24-93, standard deviation 13.6). Spacer types were (1) molded (53%), (2) antibiotic-coated prosthesis (30%), (3) handmade (12%); and (4) prefabricated (4%). Cemented acetabular liners were used in 3% (6/185). There was no loss to follow-up during the interstage period. Spacer complications occurred in 26% (48/185). Dislocation occurred in 9% (17/185) and was associated with reduced femoral offset of >5 mm (P = .033) and increased bone loss (P = .01). Spacer fracture occurred in 8% (14/185); 12% (12/97) molded versus 8% (2/23) handmade (P = .02). Periprosthetic femur fracture was associated with increased offset >5 mm (P = .01) and extended trochanteric osteotomy (P = .001).
During 2-stage total hip arthroplasty, antibiotic-loaded cement spacers had an overall complication rate of 26%. Spacer design, acetabular and femoral bone loss, and offset restoration were significantly associated with perioperative complications. We recommend the optimization of antibiotic-loaded cement spacer placement to minimize potential complications by focusing on restoration of leg-length and offset, ensuring adequate femoral fixation and paying attention to selection of an appropriate head/neck ratio.
抗生素骨水泥间隔物在 2 期翻修全髋关节置换术中用于治疗假体关节感染。已有报道称，该间隔物会导致脱位和假体周围骨折等并发症，但缺乏对间隔物设计特征的大型队列研究。本研究旨在确定间隔物设计是否与围手术期并发症相关。
我们对 2004 年至 2014 年间植入的抗生素骨水泥间隔物进行了回顾性研究。影像学评估包括肢体长度、偏心距和骨丢失（Paprosky 分类）。临床结果包括脱位、假体周围骨折、间隔物骨折、感染治愈和总再手术率。采用单因素分析、Student's t 检验、卡方检验或 Kruskal-Wallis 检验（P<.05）。
共 185 例患者接受了治疗：42%为女性，平均年龄为 64 岁（范围 24-93 岁，标准差 13.6 岁）。间隔物类型为（1）模制（53%）、（2）抗生素涂层假体（30%）、（3）手工制作（12%）和（4）预制（4%）。使用水泥髋臼衬垫的占 3%（6/185）。在 2 期治疗期间，无患者失访。185 例患者中， spacer 并发症发生率为 26%（48/185）。脱位发生率为 9%（17/185），与股骨偏心距减少>5mm（P=.033）和骨丢失增加（P=.01）相关。间隔物骨折发生率为 8%（14/185），其中 12%（12/97）为模制，8%（2/23）为手工（P=.02）。股骨假体周围骨折与偏心距增加>5mm（P=.01）和延长的转子间截骨术（P=.001）相关。
在 2 期全髋关节置换术中，抗生素负载骨水泥间隔物的总体并发症发生率为 26%。间隔物设计、髋臼和股骨骨丢失以及偏心距恢复与围手术期并发症显著相关。我们建议通过关注肢体长度和偏心距的恢复、确保股骨固定充分以及注意选择合适的头/颈比，来优化抗生素负载骨水泥间隔物的放置，以尽量减少潜在并发症。
