Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany.
Oper Orthop Traumatol. 2023 Jun;35(3-4):179-187. doi: 10.1007/s00064-023-00802-0. Epub 2023 Apr 11.
Periprosthetic joint infection remains a common and serious complication after hip arthroplasty. To improve function and patient comfort after joint removal in two-stage revision, commercially manufactured spacers for the hip joint allow retention of the anatomical joint geometry thereby limiting soft tissue contraction and allow mobilization.
Periprosthetic joint infection of the hip, septic arthritis with severe destruction of the hip cartilage and/or bone requiring arthroplasty.
Allergies to polymethylmethacrylate (PMMA) or antibiotics, severe hip dysplasia with insufficient cranial support, incompliant patient, large osseous defect of the acetabulum, insufficient metaphyseal/diaphyseal support of the femoral bone, resistance of the microbiological pathogen to spacer-inert antibiotic medication, inability to perform primary wound closure requiring temporary open-wound therapy.
Preoperative templating on radiograph; removal of joint prosthesis and thorough debridement with removal of all foreign material; trial spacer selection and insertion and trial reduction of the joint, fixing the spacer with PMMA to the proximal femur, final reduction, radiograph and stability test.
Data were analyzed from patients treated between 2016 and 2021. In all, 20 patients were treated with preformed spacers and 16 with custom-made spacers. Pathogens were detected in 23 of the 36 cases (64%). Polymicrobial infections were present in 8 of 36 cases (22%). In patients who received preformed spacers, there were 6 cases of spacer-related complications (30%). Of the 36 patients (83%), 30 were reimplanted with a new implant; 3 patients died due to septic or other complications before reimplantation (8%). Average follow-up was 20.2 months after reimplantation. There were no major differences between the two groups of spacers. Patient comfort was not measured.
髋关节置换术后，假体周围关节感染仍然是一种常见且严重的并发症。为了在两阶段翻修中关节切除后改善功能和患者舒适度，商业制造的髋关节间隔器允许保留解剖关节几何形状，从而限制软组织收缩并允许活动。
髋关节假体周围感染、伴有髋关节软骨和/或骨严重破坏的化脓性关节炎，需要进行关节置换。
对聚甲基丙烯酸甲酯（PMMA）或抗生素过敏、严重髋关节发育不良伴头侧支撑不足、不配合的患者、髋臼大骨缺损、股骨骨干骺端支持不足、微生物病原体对间隔器惰性抗生素药物耐药、无法进行一期伤口闭合需要临时开放伤口治疗。
术前在 X 线片上进行模板设计；切除关节假体并彻底清创，去除所有异物；试装间隔器选择和插入，并试复位关节，用 PMMA 将间隔器固定到股骨近端，最终复位，拍摄 X 线片并进行稳定性测试。
分析了 2016 年至 2021 年期间治疗的患者数据。共有 20 例患者接受预制间隔器治疗，16 例患者接受定制间隔器治疗。在 36 例中，有 23 例（64%）检测到病原体。36 例中有 8 例（22%）为混合感染。接受预制间隔器治疗的患者中有 6 例发生与间隔器相关的并发症（30%）。在 36 例患者中（83%），有 30 例用新植入物重新植入；在重新植入前，有 3 例患者因脓毒症或其他并发症死亡（8%）。重新植入后的平均随访时间为 20.2 个月。两种间隔器之间没有显著差异。未测量患者舒适度。
