Heckmann Nathanael D, Wang Jennifer C, Richardson Mary K, Biedermann Brett M, DiGiovanni Ryan M, Christ Alexander B, Longjohn Donald B, Oakes Daniel A
Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
Arthroplast Today. 2024 Aug 10;29:101422. doi: 10.1016/j.artd.2024.101422. eCollection 2024 Oct.
Two-stage exchange arthroplasty remains the gold standard for treating chronic hip periprosthetic joint infections. However, controversy remains regarding the optimal spacer type, particularly among patients with increased dislocation risk. This study reports on the outcomes of articulating hip spacers utilizing a single constrained-liner design.
All patients who underwent treatment for hip periprosthetic joint infection at a single institution were screened. Patients were included if they received an articulating spacer utilizing a constrained liner of a single manufacturer design. Indications for constrained liner, demographic variables, and surgical variables were recorded. Patients were assessed for dislocation and component loosening prior to the second stage or at the final follow-up if the second stage was not undertaken. Comparative analysis was performed.
Overall, 26 constrained liners were utilized in 25 patients. Indications for constrained liner included history of dislocation (n = 14), massive proximal femoral bone loss (n = 14), greater trochanteric deficiency (n = 12), and absent abductors (n = 7). Many patients had more than one indication. In total, 9 hips (34.6%) underwent a second stage at an average of 7.4 months, while 17 hips never underwent a second stage with an average follow-up of 27.6 months. One patient experienced failure of their constrained liner prior to the second stage due to pelvic discontinuity and massive acetabular bone loss.
Utilization of a constrained liner as an articulating spacer is a viable option for patients at high risk of instability. Meticulous cement technique, appropriate component position, and implant selection are crucial in achieving successful outcomes.
两阶段关节置换术仍然是治疗慢性髋关节假体周围感染的金标准。然而，关于最佳间隔物类型仍存在争议，尤其是在脱位风险增加的患者中。本研究报告了采用单一受限衬垫设计的髋关节活动间隔物的治疗结果。
对在单一机构接受髋关节假体周围感染治疗的所有患者进行筛查。如果患者接受了采用单一制造商设计的受限衬垫的活动间隔物，则纳入研究。记录受限衬垫的适应症、人口统计学变量和手术变量。在第二阶段之前或如果未进行第二阶段，则在最终随访时评估患者的脱位和组件松动情况。进行了比较分析。
总体而言，25例患者使用了26个受限衬垫。受限衬垫的适应症包括脱位史（n = 14）、股骨近端大量骨质流失（n = 14）、大转子缺损（n = 12）和外展肌缺失（n = 7）。许多患者有不止一项适应症。共有9个髋关节（34.6%）平均在7.4个月时进行了第二阶段手术，而17个髋关节从未进行第二阶段手术，平均随访27.6个月。一名患者在第二阶段之前因骨盆连续性中断和髋臼大量骨质流失而出现受限衬垫失败。
对于不稳定风险高的患者，使用受限衬垫作为活动间隔物是一种可行的选择。精细的骨水泥技术、合适的组件位置和植入物选择对于取得成功的结果至关重要。
