Orthopaedic Surgery Department, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain; Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.; Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain. Universidad Autónoma de Barcelona (UAB).
Orthopaedic Surgery Department, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain; Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain. Universidad Autónoma de Barcelona (UAB).
Injury. 2021 Mar;52(3):606-615. doi: 10.1016/j.injury.2020.10.016. Epub 2020 Oct 6.
Infected post-traumatic distal femur defects remain a therapeutic challenge. Non-biological reconstruction offers an option for avoiding complex biological knee arthrodesis procedures. The Compress implant is an alternative to the traditional distal femur stemmed megaprosthesis. The aim of this study is to analyse the first patients treated with a distal femur Compress prosthesis to manage massive infected post-traumatic defects of the distal femur with joint involvement.
We retrospectively reviewed all patients with massive infected defects of the distal femur where this implant was used in a two-stage strategy, together with an antibacterial coating hydrogel (DAC). The specific protocol, microbiological data, clinical and radiological results, complications, functional results and prosthesis survivorship were determined. Follow-up was for a minimum of 12 months, or until implant removal.
Ten patients (11 Compress implants) with a mean age of 52 years (range 35-73) were included. On average, patients had undergone 4.4 previous surgical procedures before index surgery. The mean bone defect was 14 cm (range 8-21). After a median follow-up of 27 months (range 12-50 months) no patient had presented with recurrence of the infection, and limb salvage was achieved in all cases. Two patients suffered aseptic loosening which required revision of the femoral component. The short-term survivorship of the implant in our series was 81.8% at 4 years, with all failures occurring in the first 7 months. After this 7-month time threshold, we encountered no further loosening. Regarding functional outcomes, patients had a mean knee ROM of -4/86, expressed high overall satisfaction with the procedure according to the SAPS scale, and had an average LEFS of 52.5% (40-72.5%).
Non-biological reconstruction of the distal femur with the Compress implant is a valid option in selected patients with massive infected defects with joint involvement. Survivorship was high, with all loosening occurring in the first months after surgery-representing a failure in the osseointegration of the implant.
感染性创伤后股骨远端缺损仍然是一个治疗挑战。非生物重建为避免复杂的生物膝关节融合术提供了一种选择。Compress 植入物是传统股骨远端带柄假体的替代物。本研究的目的是分析采用股骨远端 Compress 假体治疗伴有关节受累的股骨远端大块感染性创伤后缺损的首批患者。
我们回顾性分析了所有接受两阶段治疗的股骨远端大块感染性缺损患者的资料，其中包括使用抗菌涂层水凝胶（DAC）。确定了特定方案、微生物数据、临床和影像学结果、并发症、功能结果和假体存活率。随访时间至少为 12 个月，或直至假体取出。
10 例患者（11 个 Compress 假体），平均年龄 52 岁（35-73 岁）。平均而言，患者在指数手术前接受了 4.4 次手术。平均骨缺损为 14cm（8-21cm）。中位随访 27 个月（12-50 个月）后，无患者出现感染复发，所有病例均保留了肢体。2 例发生无菌性松动，需要对股骨部件进行翻修。本研究中，假体的短期存活率为 4 年时的 81.8%，所有失败均发生在最初的 7 个月内。在这个 7 个月的时间阈值之后，我们没有再遇到松动。在功能结果方面，患者的膝关节活动度平均为-4/86，根据 SAPS 量表，他们对手术表示高度满意，平均 LEFS 为 52.5%（40-72.5%）。
在伴有关节受累的大块感染性缺损的患者中，采用 Compress 假体进行非生物性股骨远端重建是一种有效的选择。存活率较高，所有松动均发生在手术后的前几个月，这代表了假体的骨整合失败。
