Garceau Simon, Warschawski Yaniv, Sanders Ethan, Gross Allan, Safir Oleg, Kuzyk Paul
Mount Sinai Hospital, Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Toronto, ON, Canada.
J Arthroplasty. 2019 Sep;34(9):2107-2110. doi: 10.1016/j.arth.2019.04.051. Epub 2019 Apr 30.
Dislocation of dynamic antibiotic hip spacers during the treatment of periprosthetic joint infection is a well-described complication. Unfortunately, the repercussions of such events after reimplantation of the definitive prosthesis remain largely unknown. As such, we devised a study comparing the perioperative and postoperative outcomes of patients having undergone reimplantation with and without spacer dislocation.
A search of our institutional database was performed. Two retrospective cohorts were created: dislocated and nondislocated hip spacers. The radiographic and clinical outcomes for each cohort were collected.
The two retrospective cohorts contained 24 patients for the dislocated group and 66 for the nondislocated group. Continuous variables noted to be significantly different between the dislocated and nondislocated groups were as follows: clinical leg-length discrepancy (1.35 cm vs 0.41 cm, P = .027), acetabular center of rotation (1.34 cm vs 0.60 cm, P = .011), total packed red blood cell transfusions (4.05 vs 2.37, P = .019), operative time (177.4 min vs 147.3 min, P = .002), and hospital length of stay (7.79 days vs 5.89 days, P = .018). Categorical variables noted to be significantly different were requirement for complex acetabular reconstruction (58.3% vs 13.7%, P < .001), requirement of constrained liners (62.5% vs 37.3%, P = .040), and dislocation after second stage (20.8% vs 6.1%, P = .039).
Dislocation of dynamic hip spacers leads to inferior clinical results and perioperative outcomes after reimplantation of the definitive prosthesis. Additionally, complex acetabular reconstruction is often required. As such, every effort should be made to prevent hip spacer dislocation.
在治疗假体周围关节感染期间，动态抗生素髋关节间隔器脱位是一种已被充分描述的并发症。不幸的是，在重新植入最终假体后，此类事件的后果在很大程度上仍不清楚。因此，我们设计了一项研究，比较有和没有间隔器脱位的患者在重新植入后的围手术期和术后结果。
对我们的机构数据库进行了检索。创建了两个回顾性队列：脱位和未脱位的髋关节间隔器。收集了每个队列的影像学和临床结果。
两个回顾性队列中，脱位组有24例患者，未脱位组有66例患者。脱位组和未脱位组之间存在显著差异的连续变量如下：临床腿长差异（1.35厘米对0.41厘米，P = 0.027）、髋臼旋转中心（1.34厘米对0.60厘米，P = 0.011）、总浓缩红细胞输注量（4.05对2.37，P = 0.019）、手术时间（177.4分钟对147.3分钟，P = 0.002）和住院时间（7.79天对5.89天，P = 0.018）。存在显著差异的分类变量为复杂髋臼重建的需求（58.3%对13.7%，P < 0.001）、限制性衬垫的需求（62.5%对37.3%，P = 0.040）以及二期手术后脱位（20.8%对6.1%，P = 0.039）。
动态髋关节间隔器脱位会导致在重新植入最终假体后临床结果和围手术期结果较差。此外，通常需要进行复杂的髋臼重建。因此，应尽一切努力防止髋关节间隔器脱位。
