Department of Orthopedic Surgery, Center for Joint Disease at Chonnam National University Hwasun Hospital, 322, Seo Yang-Ro, Hwasun-Eup, Hwasun-Gun, Jeonnam, 519-809, Republic of Korea.
Department of Orthopedic Surgery, Center for Joint Disease, Affiliated Hospital of Yanbian University, Yanji, China.
J Orthop Surg Res. 2020 Sep 29;15(1):443. doi: 10.1186/s13018-020-01950-w.
Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is widely used in two-stage revision arthroplasty in periprosthetic joint infection (PJI) after total hip arthroplasty (THA). In our institution, we encountered several cases of acetabular cement spacer dislodgement. The aim of this study was to compare the results of two-stage revision arthroplasties with antibiotic-loaded cement spacers with or without screws on the acetabulum for PJI.
This retrospective study included 44 patients who underwent a two-stage revision THA for PJI from June 2007 to May 2017. We divided the patients into two groups: group 1 consisted of 21 patients (21 hips) who underwent two-stage revision arthroplasty with screw augmentation, while group 2 consisted of 23 patients (23 hips) who underwent the same surgery without screw augmentation at the acetabular cement spacer. We compared the migration and dislodgement of the acetabular cement spacer between the two groups.
Before the second-stage surgery, there was less vertical migration of the cement spacer in group 1 compared to group 2 (1.2 mm vs 3.1 mm, p < 0.001). There was also less medial migration of the cement spacer in group 1 (0.6 mm vs 1.6 mm, p = 0.001). After the first stage, the mean Harris Hip score was significantly higher in group 1 than in group 2 (75 vs 65, p = 0.033). Cement spacer rotation or total movement out of the acetabular area occurred in six patients, all in group 2. After first stage reinfection occurred in two patients, one in each group.
Screw augmentation to the acetabulum in the first-stage surgery provides better stability of acetabular antibiotic cement spacers without increasing reinfection rate.
在全髋关节置换术后假体周围关节感染（PJI）的二期翻修中，抗生素负载丙烯酸水泥假体（PROSTALAC）被广泛应用。在我们的机构中，我们遇到了几例髋臼水泥间隔物移位的情况。本研究旨在比较二期翻修术伴或不伴髋臼螺钉固定的抗生素水泥间隔物治疗 PJI 的结果。
本回顾性研究纳入了 2007 年 6 月至 2017 年 5 月期间因 PJI 行二期翻修 THA 的 44 例患者。我们将患者分为两组：组 1 包括 21 例患者（21 髋），行二期翻修术伴螺钉增强；组 2 包括 23 例患者（23 髋），行相同手术但髋臼水泥间隔物不伴螺钉增强。我们比较了两组髋臼水泥间隔物的迁移和移位情况。
在二期手术前，组 1 的水泥间隔物垂直迁移小于组 2（1.2mm 比 3.1mm，p < 0.001）。组 1 的水泥间隔物内侧迁移也较小（0.6mm 比 1.6mm，p = 0.001）。第一阶段后，组 1 的 Harris 髋关节评分显著高于组 2（75 比 65，p = 0.033）。6 例患者（均在组 2）发生水泥间隔物旋转或完全移出髋臼区域，2 例患者（每组 1 例）在第一阶段后发生再感染。
在第一阶段手术中对髋臼进行螺钉增强可提供更好的髋臼抗生素水泥间隔物稳定性，而不会增加再感染率。
