Hardt Sebastian, Leopold Vincent Justus, Khakzad Thilo, Pumberger Matthias, Perka Carsten, Hipfl Christian
Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
J Clin Med. 2021 Dec 22;11(1):36. doi: 10.3390/jcm11010036.
This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement.
Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years.
Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group ( = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation ( < 0.01).
ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.
本研究旨在比较在有或没有使用延长转子截骨术（ETO）以取出固定良好的股骨柄或骨水泥的情况下，两阶段翻修全髋关节置换术（THA）治疗假体周围感染（PJI）的结果。
32例接受了ETO作为两阶段翻修一部分且未放置间隔物的患者，与64例年龄和性别相同、未进行任何截骨术而取出股骨柄的患者按1:2进行匹配。评估临床结果，包括中期翻修、再感染和无菌性失败率。计算改良Harris髋关节评分（mHHS）。最短随访时间为两年。
与未行ETO的患者相比，接受ETO的患者中期再次清创率显著更低（0%对14.1%，P = 0.026）。两组再植入后的再感染情况相似（ETO组为12.5%，未行ETO组为9.4%，P = 0.365）。ETO组因无菌原因进行翻修的比例为12.5%，未行ETO组为14.1%（P = 0.833）。3例患者（3.1%）出现假体周围股骨骨折，均发生在未行ETO的患者中。脱位是最常见的并发症，两组发生率相同（12.5%）。ETO组的平均mHHS为37.7，未行ETO组为37.3，两组再植入后这些评分均显著改善（P < 0.01）。
不使用间隔物的ETO是处理股骨柄固定良好的患者以及在两阶段翻修THA治疗PJI时彻底清除骨水泥的一种安全有效的方法。虽然它可能会降低中期重复清创的发生率，但使用ETO似乎会导致再植入后的再感染率相似。
