Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Germany.
Klinik für Orthopädie und Unfallchirurgie, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
Z Orthop Unfall. 2022 Jun;160(3):317-323. doi: 10.1055/a-1340-0890. Epub 2021 Feb 4.
Revision arthroplasty involving mega-implants is associated with a high complication rate. In particular, infection is a serious complication of revision arthroplasty of hip and knee joints and has been reported to have an average rate of 18%, and for mega-implants, the range is from 3 to 36%. This study was designed to analyze the strategy of treatment of infection of mega-endoprostheses of the lower extremities in our patient cohort, particularly the management of chronic infection.
This was a retrospective study that focused on the results of the treatment of periprosthetic infections of mega-implants of the lower extremities. We identified 26 cases with periprosthetic infections out of 212 patients with 220 modular mega-endoprostheses of the lower extremities who were treated in our department between September 2013 and September 2019. As a reinfection or recurrence, we defined clinical and microbiological recurrences of local periprosthetic joint infections after an antibiotic-free period.
In this study, 200 cases out of 220 were investigated. The average follow-up period was approximately 18 months (6 months to 6 years). Endoprosthesis infections after implantation of mega-implants occurred in 26 cases (13%). This group comprised 2 early infections (within the first 4 weeks) and 24 chronic infections (between 10 weeks and 6 years after implantation). Nineteen cases out of the identified 26 cases with infection (73.1%) belong to the group of patients who were operated on due to major bone loss following explantation of endoprosthetic components due to previous periprosthetic joint infection. The remaining seven cases with infection comprised four cases following management of periprosthetic fracture, two cases following treatment of aseptic loosening, and one case following tumor resection. All infections were treated surgically. In all cases, the duration of continuous antibiotic treatment did not exceed 6 weeks. Both cases with early infection were treated by exchanging polyethylene inlays and performing debridement with lavage (two cases). In two (7.7%) cases with chronic infection, one-stage surgery was performed. In all remaining cases with chronic infection (22 cases; 84.6%), explantation of all components and temporary implantation of cement spacers were carried out prior to reimplantation.
There is still no gold standard therapeutic regimen for the management of periprosthetic infection of mega-implants, though radical surgical debridement and lavage accompanied by systemic antibiotic therapy are the most important therapeutic tools in all cases of periprosthetic infections, regardless of the time of onset. Further studies are needed to standardize management strategies of such infections. Nevertheless, it is not uncommon for compromises to be made based on the particular condition of the individual.
涉及大型植入物的翻修关节置换术与高并发症发生率相关。特别是，感染是髋关节和膝关节翻修术的严重并发症，据报道其平均发生率为 18%，而对于大型植入物，范围为 3%至 36%。本研究旨在分析我们患者队列中下肢大型内植物感染的治疗策略，特别是慢性感染的管理。
这是一项回顾性研究，重点关注下肢大型植入物假体周围感染治疗的结果。我们在 2013 年 9 月至 2019 年 9 月期间，在我部门治疗的 212 例下肢 220 个模块化大型内植物患者中，确定了 26 例假体周围感染病例。我们将局部假体关节感染抗生素治疗后 1 年无临床和微生物学复发定义为再感染或复发。
本研究共调查了 220 例中的 200 例，平均随访时间约为 18 个月（6 个月至 6 年）。26 例（13%）在植入大型植入物后发生内植物感染。该组包括 2 例早期感染（在最初 4 周内）和 24 例慢性感染（植入后 10 周至 6 年）。在确定的 26 例感染病例中，19 例（73.1%）属于因先前假体周围关节感染而进行内植物组件取出导致严重骨质丢失的患者。其余 7 例感染病例包括 4 例假体周围骨折治疗后、2 例无菌性松动治疗后和 1 例肿瘤切除后。所有感染均采用手术治疗。在所有情况下，持续抗生素治疗的时间均不超过 6 周。早期感染的两例病例均采用更换聚乙烯衬垫和冲洗清创（两例）治疗。两例（7.7%）慢性感染患者进行了一期手术。在所有慢性感染（22 例；84.6%）病例中，所有组件均被取出，并在重新植入前暂时植入水泥间隔物。
目前，对于大型植入物假体周围感染的治疗，仍没有金标准治疗方案，尽管彻底的手术清创和冲洗以及全身性抗生素治疗是所有假体周围感染病例最重要的治疗手段，无论感染发生的时间如何。需要进一步的研究来规范此类感染的管理策略。然而，根据个体的特殊情况，做出妥协并不罕见。
