Department of Orthopedic Surgery and Traumatology, Charité, University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Department of Orthopedics & Sports Medicine, Baylor College of Medicine Medical Center, Houston, TX, USA.
Arch Orthop Trauma Surg. 2023 Apr;143(4):2199-2207. doi: 10.1007/s00402-022-04463-9. Epub 2022 May 9.
A devastating complication after total hip arthroplasty (THA) is chronic periprosthetic joint infection (PJI). Most frequently spacers (Sp) with or without antibiotics are implanted in a two-stage procedure even though not always indicated due to unknown pathogen, femoral and acetabular defects or muscular insufficiency.
A retrospective analysis of a prospectively collected database was conducted, analyzing the treatment of 44 consecutive cases with chronic PJI undergoing two-stage revision using a Girdlestone situation (GS) in the interim period between 01/2015 and 12/2018. Diagnostics included intraoperative microbiological cultures, histological analysis, sonication of the initial implant, analysis of hip aspiration, as well as laboratory diagnostics and blood cultures. We analyzed the general and age-group-specific success rate of treatment using GS. Furthermore, we compared our data with the current literature on spacer implantation regarding common complications.
In total, 21 female and 23 male patients at a mean age of 59.3 ± 9.6 years were included. Age groups were divided into young, mid-age, and elderly. In most patients, microbiology revealed Staphylococcus epidermidis in 39.1% of cases, following Staphylococcus lugdunensis and Staphylococcus aureus in 10.9% after THA explantation. For histology, Krenn and Morawietz type 2 (infectious type) was diagnosed in 40.9%, type 3 (infectious and abrade-induced type) in 25.0%. With GS, the total cure rate was 84.1% compared to 90.1% (range 61-100%) using Sp as described in the literature. Among age-groups, cure rate varied between 77.8 and 100%. Other complications, which only occurred in the mid-age and elderly group, included the necessity of transfusion in 31.1%, and in total, one periprosthetic fracture was identified (2.3%).
GS shows an acceptable cure rate at a minimum of 2 years when compared to the cure rate reported in the literature for Sp without major complications. For patients with increased risks for treatment failure using spacer, GS seems to be an alternative for chronic PJI when looking at the success rate of treatment.
III, Retrospective trial.
全髋关节置换术后（THA）的一种毁灭性并发症是慢性假体周围关节感染（PJI）。即使由于未知病原体、股骨和髋臼缺陷或肌肉不足等原因并非总是需要，大多数情况下仍会在两期手术中植入间隔物（Sp），同时使用或不使用抗生素。
对 2015 年 1 月至 2018 年 12 月期间采用 Girdlestone 术（GS）治疗 44 例慢性 PJI 连续性病例的前瞻性数据库进行回顾性分析。诊断包括术中微生物培养、组织学分析、初次植入物的超声检查、髋关节抽吸分析，以及实验室诊断和血液培养。我们使用 GS 分析 GS 治疗的总体和年龄组特定成功率。此外，我们将我们的数据与关于 Sp 植入的当前文献中的数据进行比较，以了解常见并发症。
共纳入 21 名女性和 23 名男性患者，平均年龄为 59.3±9.6 岁。年龄组分为年轻、中年和老年。在大多数患者中，微生物学显示表皮葡萄球菌在 39.1%的病例中，THA 取出后紧随其后的是路邓葡萄球菌和金黄色葡萄球菌分别为 10.9%。组织学方面，Krenn 和 Morawietz 2 型（感染型）诊断为 40.9%，3 型（感染和磨损诱导型）为 25.0%。使用 GS，总治愈率为 84.1%，而文献中描述的 Sp 为 90.1%（范围为 61-100%）。在年龄组中，治愈率在 77.8%至 100%之间变化。仅在中年和老年组中发生的其他并发症包括 31.1%需要输血，总共有 1 例假体周围骨折（2.3%）。
与文献中报道的 Sp 治疗慢性 PJI 的治愈率相比，GS 在至少 2 年时具有可接受的治愈率，且无重大并发症。对于使用 Sp 治疗失败风险增加的患者，当考虑治疗成功率时，GS 似乎是慢性 PJI 的替代方法。
III，回顾性试验。
