Heckmann Nathanael D, Biedermann Brett M, Richardson Mary K, Chen Matthew S, Gettleman Brandon S, Liu Kevin C, Christ Alexander B, Longjohn Donald B, Oakes Daniel A
Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
J Arthroplasty. 2025 Aug;40(8):1952-1960. doi: 10.1016/j.arth.2025.01.044. Epub 2025 Jan 28.
The two-stage surgical protocols used for the treatment of periprosthetic joint infection following total knee arthroplasty are associated with marked patient morbidity. As such, alternatives, such as durable "1.5-stage" spacer constructs, have gained popularity. We sought to describe the outcomes of a novel "1.5-stage" spacer construct utilizing revision stemmed-tibia implants.
Patients who underwent a "1.5-stage" for the management of a knee periprosthetic joint infectionat our institution were screened for inclusion. A "1.5-stage" was defined as a spacer placed with the intent of not performing a second stage, without the use of press-fit stems or cemented intramedullary fixation as is often done during a single-stage protocol. Procedures were categorized into two groups based on construct type: (1) hand-made constructs utilizing all-polyethylene tibial components; or (2) constructs utilizing stemmed-revision components precoated with cement before insertion. Patient demographics, comorbidities, and surgical details were collected and reported. The two-year Kaplan-Meier survival estimates for all-cause revision, revision for spacer loosening, and revision due to infection recurrence were reported. In total, 46 "1.5-stage" procedures were identified, including 12 handmade and 34 stemmed-revision constructs.
The stemmed-revision cohort was less likely to undergo reoperation for any reason (17.6 versus 50.0%, P = 0.028) or a revision for spacer loosening (0.0 versus 25.0%, P = 0.003) compared to the hand-made cohort. There were no differences with respect to infection recurrence or time to revision. The 2-year survival from revision for loosening was higher in the stemmed cohort compared to the handmade cohort though not statistically different (100%, 95% CI [confidence interval]: 2.5 to 100.0 versus 72.9%, 95% CI: 26.3 to 96.6%, P = 0.330).
A "1.5-stage" spacer construct using stemmed-revision components was associated with promising short-term results. Durable spacer constructs may be a viable option for select patients; however, longer-term follow-up is needed to identify patients who stand to benefit the most from this technique.
全膝关节置换术后用于治疗假体周围关节感染的两阶段手术方案会给患者带来明显的发病率。因此，诸如耐用的“1.5阶段”间隔物构建体等替代方案已受到欢迎。我们试图描述一种利用翻修带柄胫骨植入物的新型“1.5阶段”间隔物构建体的结果。
对在我们机构接受“1.5阶段”手术治疗膝关节假体周围关节感染的患者进行纳入筛查。“1.5阶段”被定义为放置间隔物的目的是不进行第二阶段手术，且不使用压配柄或在单阶段手术中常用的骨水泥髓内固定。根据构建体类型将手术分为两组：（1）使用全聚乙烯胫骨部件的手工制作构建体；或（2）使用在插入前预涂骨水泥的带柄翻修部件的构建体。收集并报告患者的人口统计学、合并症和手术细节。报告了全因翻修、间隔物松动翻修和感染复发翻修的两年Kaplan-Meier生存估计值。总共确定了46例“1.5阶段”手术，包括12例手工制作构建体和34例带柄翻修构建体。
与手工制作组相比，带柄翻修组因任何原因再次手术的可能性较小（17.6%对50.0%，P = 0.028）或因间隔物松动进行翻修的可能性较小（0.0%对25.0%，P = 0.003）。在感染复发或翻修时间方面没有差异。带柄组因松动翻修后的2年生存率高于手工制作组，尽管差异无统计学意义（100%，95%置信区间[CI]：2.5至100.0%对72.9%，95% CI：26.3至96.6%，P = 0.330）。
使用带柄翻修部件的“1.5阶段”间隔物构建体具有良好的短期效果。耐用的间隔物构建体可能是部分患者的可行选择；然而，需要更长时间的随访来确定从该技术中受益最大的患者。
