McPherson Edward J, Crawford Brooke M, Kenny Steven G, Dipane Matthew V, Salarkia Shahrzad, Stavrakis Alexandra I, Chowdhry Madhav
Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Orthopedic Surgery, The University of Miami Miller School of Medicine, Miami, FL, USA.
Arthroplast Today. 2024 Jan 22;25:101302. doi: 10.1016/j.artd.2023.101302. eCollection 2024 Feb.
Infection rates in revision total hip arthroplasty are lower when antibiotic loaded cemented stems are utilized. Inspired by this technique, a point-of-care coating of antibiotic-loaded calcium sulfate (CaSO) was applied to cementless revision stems in aseptic revision and 2nd stage reimplantation total hip arthroplasty.
One hundred eleven consecutive femoral stems were coated. Just prior to insertion, 10 cc of CaSO was mixed with 1 g vancomycin and 240 mg tobramycin with the paste applied to the stem. The results were compared to a matched cohort (N = 104) performed across the previous 5 years. The surgical methods were comparable, but for the stem coating. The study group was followed for a minimum of 3 years.
In the study cohort of 111 patients, there were 69 aseptic revisions with one periprosthetic joint infection (PJI) (1.4%) and 42 second-stage reimplantations with 2 PJIs (4.8%). In the control cohort of 104 patients, there were 74 aseptic revisions with one PJI (1.4%) and 30 second-stage reimplantations with 7 PJIs (23.3%). There was no significant reduction in PJI rate in the aseptic revision subgroup (1.4% study vs 1.4% control group), = 1.000. Antibiotic stem coating reduced PJI rate in the 2nd stage reimplantation subgroup (23.3% control vs 4.8% study group), = .028. In both groups, there were no cases of aseptic stem loosening.
Point-of-care antibiotic coating of cementless revision femoral stems reduces PJI infection rate in 2nd stage reimplantations only. We theorize that microbes persist in the endosteal cortices after resection and may contribute to infection recurrence.
使用含抗生素的骨水泥柄进行翻修全髋关节置换术时感染率较低。受此技术启发，在无菌翻修和二期再植入全髋关节置换术中，将含抗生素的硫酸钙（CaSO）即时护理涂层应用于非骨水泥翻修柄。
连续对111个股骨柄进行涂层处理。在插入前，将10 cc的CaSO与1 g万古霉素和240 mg妥布霉素混合，制成糊剂涂抹在柄上。将结果与过去5年中匹配的队列（N = 104）进行比较。手术方法具有可比性，但柄涂层不同。研究组至少随访3年。
在111例患者的研究队列中，有69例无菌翻修，1例假体周围关节感染（PJI）（1.4%），42例二期再植入，2例PJI（4.8%）。在104例患者的对照队列中，有74例无菌翻修，1例PJI（1.4%），30例二期再植入，7例PJI（23.3%）。无菌翻修亚组的PJI率无显著降低（研究组1.4% vs对照组1.4%），P = 1.000。抗生素柄涂层降低了二期再植入亚组的PJI率（对照组23.3% vs研究组4.8%），P = 0.028。两组均无无菌性柄松动病例。
非骨水泥翻修股骨干的即时护理抗生素涂层仅降低二期再植入时的PJI感染率。我们推测，切除后微生物在内皮层皮质中持续存在，可能导致感染复发。
