Uehara Kazuya, Shiigi Eiichi, Seki Kazushige, Imagama Takashi, Seki Toshihiro, Tanaka Hiroshi, Sakai Takashi
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, JPN.
Department of Orthopedic Surgery, Yamaguchi Prefectural Grand Medical Center, Hofu, JPN.
Cureus. 2024 Dec 9;16(12):e75404. doi: 10.7759/cureus.75404. eCollection 2024 Dec.
Two-stage revision is known as the gold-standard method for knee prosthetic joint infection (PJI), but the most suitable treatment method remains controversial. Typically, weight-bearing is restricted during the interval between the stages. The aim of this study was to evaluate the clinical outcomes of unrestricted weight bearing with cement spacers fabricated using the Knee Articulating Spacer Mold (KASM®; Ortho Development Corporation, Draper, UT, USA) for knee PJI.
We retrospectively reviewed 16 patients who underwent two-stage revision surgery for knee PJI between April 2015 and March 2020. The procedure involved the removal of the infected prosthetic joints and the insertion of cement spacers made using KASM®. The evaluation focused on the possibility of full-weight bearing gait during the interval between the first and second stages, surgical time, blood loss, complications, and postoperative outcomes, including the Knee Society Score (KSS), Knee Society Function Score, and range of motion (ROM).
All patients were able to walk with full weight-bearing. However, cement spacer dislocation occurred in one patient (6.3%). During the interval between stages, infection occurred in one patient (6.3%) and debridement was performed. Average interval between the stages was 92.7 days (range, 55-166 days). After the reimplantation, reinfection occurred in two patients (12.5%) out of the 16. Among the 14 patients with successful reimplantation, the average operative time was 116.1 min (range, 76-153 min) and the average perioperative blood loss was 476.1 mL (range, 89.5-859 mL). The KSS was 86.4 (range, 62-100), the Knee Society Function Score was 73.6 (range, 45-100), and flexion ROM was 111.8° (range, 95°-130°) at the latest follow-up. The mean follow-up period was 871 days (range, 117-1103 days).
Unrestricted weight-bearing gait using cement spacers during the waiting period for two-stage revision surgery for knee PJI led to favorable outcomes in this case series, which lacked a control group. Further studies are needed to assess whether the benefits of weight-bearing outweigh the risks and improve overall outcomes.
两阶段翻修术是膝关节假体周围感染（PJI）的金标准治疗方法，但最合适的治疗方法仍存在争议。通常，在两阶段之间的间隔期会限制负重。本研究的目的是评估使用膝关节活动间隔器模具（KASM®；美国犹他州德雷珀市奥索发展公司）制作的骨水泥间隔器在膝关节PJI患者中进行无限制负重的临床效果。
我们回顾性分析了2015年4月至2020年3月期间接受膝关节PJI两阶段翻修手术的16例患者。手术包括取出感染的假体关节并植入使用KASM®制作的骨水泥间隔器。评估重点在于第一阶段和第二阶段之间的间隔期内实现全负重步态的可能性、手术时间、失血量、并发症以及术后结果，包括膝关节协会评分（KSS）、膝关节协会功能评分和活动范围（ROM）。
所有患者均能够全负重行走。然而，1例患者（6.3%）发生了骨水泥间隔器脱位。在两阶段之间的间隔期，1例患者（6.3%）发生感染并进行了清创。两阶段之间的平均间隔期为92.7天（范围55 - 166天）。再次植入后，16例患者中有2例（12.5%）发生再感染。在14例成功再次植入的患者中，平均手术时间为116.1分钟（范围76 - 153分钟），围手术期平均失血量为476.1毫升（范围89.5 - 859毫升）。在最近一次随访时，KSS为86.4（范围62 - 100），膝关节协会功能评分为73.6（范围45 - 100），屈曲ROM为111.8°（范围95° - 130°）。平均随访期为871天（范围117 - 1103天）。
在膝关节PJI两阶段翻修手术的等待期使用骨水泥间隔器进行无限制负重步态，在本病例系列中取得了良好的效果，但本研究缺乏对照组。需要进一步研究以评估负重的益处是否超过风险并改善总体结果。
