Ellenrieder Martin, Surmann Bastian, Enz Andreas, Toch Sören Henning, Lenz Robert, Mittelmeier Wolfram
Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18057, Rostock, Deutschland.
Fakultät für Gesundheitswissenschaften/AG 5 Gesundheitsökonomie und Gesundheitsmanagement, Universität Bielefeld, Universitätsstr. 25, 33615, Bielefeld, Deutschland.
Orthopadie (Heidelb). 2022 Jul;51(7):564-572. doi: 10.1007/s00132-021-04185-7. Epub 2021 Oct 30.
Large femoral defects in late periprosthetic infection (PPI) after total hip arthroplasty (THA) often require the use of large, individual metal endoskeleton-reinforced cement spacers (iMECS).
The aim was to record the clinical, radiological and functional results (Harris Hip Score HHS) up to the 2 years after treatment of a PPI using an iMECS. Major patient-specific parameters were to be evaluated with regard to the treatment outcome.
The collective of this single-center retrospective cohort study comprised 29 patients. The mean follow-up was 24.4 months (range: 23.0 to 27.6 months). The absence of infection after endoprosthetic hip joint reconstruction was rated as successful treatment. The two patient groups (successful (S)/not successful (nS)) were compared with regard to gender distribution, the Charlson comorbidity index (CCI), the number of previous septic changes, and the rate of polymicrobial and difficult-to-treat infections.
The average CCI in the total collective was 6.4 points. Joint reconstruction was possible in 23 of 29 patients (79%); 2 years after PPI treatment 4 patients were not available for a follow-up examination (2 deceased, 2 unable to participate). At the time of the follow-up, 17 of the 29 patients had received a joint reconstruction and were free of infection, with an average HHS of 75 points. There were no iMECS-associated complications requiring revision. Only the initial CCI (S: 4.1 points; nS: 9.7 points) differed significantly between the patient groups (p < 0.05).
In the case of large femoral defects, iMECS provide secure temporary stabilization. The chance of a successful joint reconstruction is closely related to the individual comorbidities profile.
全髋关节置换术（THA）后晚期假体周围感染（PPI）中的大股骨缺损通常需要使用大型个体化金属内骨骼增强骨水泥间隔物（iMECS）。
本研究旨在记录使用iMECS治疗PPI后长达2年的临床、放射学和功能结果（Harris髋关节评分HHS）。主要的患者特异性参数将根据治疗结果进行评估。
本单中心回顾性队列研究共纳入29例患者。平均随访时间为24.4个月（范围：23.0至27.6个月）。人工髋关节置换术后无感染被评为治疗成功。比较两组患者（成功（S）/未成功（nS））的性别分布、Charlson合并症指数（CCI）、既往感染性病变的数量以及多微生物感染和难治性感染的发生率。
整个队列的平均CCI为6.4分。29例患者中有23例（79%）可行关节重建；PPI治疗2年后，4例患者无法进行随访检查（2例死亡，2例无法参与）。随访时，29例患者中有17例接受了关节重建且无感染，平均HHS为75分。未出现需要翻修的iMECS相关并发症。仅患者组之间的初始CCI存在显著差异（S组：4.1分；nS组：9.7分）（p < 0.05）。
对于大股骨缺损，iMECS可提供可靠的临时稳定。关节重建成功的机会与个体合并症情况密切相关。
