Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China.
Department of Orthopaedics, The 985 Hospital of PLA, Taiyuan, Shanxi, China.
J Orthop Surg Res. 2020 Oct 1;15(1):448. doi: 10.1186/s13018-020-01831-2.
Spacer complications may affect final clinical outcome of the two-stage approach in periprosthetic joint infection (PJI) patients. This study aimed to investigate clinical outcomes and complications of augmented antibiotic-loaded cement spacer in PJI patients with acetabular bone defect.
Data on PJI patients with acetabular bone defect receiving two-stage revision from January 2009 to December 2016, in our hospital were retrospectively reviewed. Screw-cement-shell was used to improve the stability of the hip with acetabular wall defect. Handmade acetabular spacer could prevent femoral spacer entering into pelvis in patients with acetabular internal wall defect. A total of 26 patients (11 males and 15 females) were included in the current study. Their mean age was 46.7 ± 15.4 years old. Clinical outcomes and complications were measured.
Twenty-one of total 26 hips (21/26, 80.8%) showed positive cultures and 15/26 (57.7%) samples were cultured with staphylococcus. Of enrolled patients, 5/26 (19.2%) developed mixed infection. There was one patient (3.8%) with spacer dislocation and two (7.7%) with spacer fracture. One patient developed acute PJI 5 years after the second-stage revision, so overall success rate among these patients was 96.2%. Differences in Paprosky classifications before the first and second stage did not reach significant level (p > 0.05). Hip Harris score was raised from 40.9 ± 14.0 to 81.2 ± 11.2 (p < 0.05).
Augmented antibiotic-loaded cement spacer could achieve satisfactory clinical outcomes in PJI patients with acetabular bone defect. It provided joint mobility, increased additional joint stability, and decreased iatrogenic bone defect caused by acetabular wear.
间隔器并发症可能会影响二期翻修治疗人工关节周围感染（PJI）患者的最终临床结果。本研究旨在探讨强化抗生素骨水泥间隔器在髋臼骨缺损 PJI 患者中的应用效果及并发症。
回顾性分析我院 2009 年 1 月至 2016 年 12 月收治的髋臼骨缺损行二期翻修的 PJI 患者的临床资料。采用螺钉-骨水泥-壳技术提高髋臼壁缺损髋关节的稳定性，对于髋臼内板缺损的患者，采用手工制作的髋臼间隔器可防止股骨间隔器进入骨盆。共纳入 26 例患者（男 11 例，女 15 例），平均年龄 46.7±15.4 岁。测量临床结果和并发症。
26 髋中 21 髋（21/26，80.8%）培养阳性，15 髋（15/26，57.7%）培养出葡萄球菌，5 髋（5/26，19.2%）为混合感染。有 1 例（3.8%）发生间隔器脱位，2 例（7.7%）发生间隔器骨折。1 例患者在二期翻修后 5 年发生急性 PJI，故患者的总体成功率为 96.2%。第一期和第二期的 Paprosky 分类差异无统计学意义（p>0.05）。髋关节 Harris 评分由 40.9±14.0 提高至 81.2±11.2（p<0.05）。
强化抗生素骨水泥间隔器治疗髋臼骨缺损 PJI 患者可获得满意的临床效果，提供关节活动度，增加关节稳定性，减少髋臼磨损引起的医源性骨缺损。
