Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Treatment of Infected Hip Arthroplasty with Antibiotic-Loaded Cement Spacers

항생제 혼합 시멘트 충전물(Antibiotics-Loaded cement spacer)을 이용한 감염된 인공 고관절 치환술의 치료

  • Cho, Yoon-Je (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Kim, Kang-Il (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Chun, Young-Soo (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Rhyu, Kee-Hyung (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Roh, Joon-Ha (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Kim, Young-Jun (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Yoo, Myung-Chul (Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
  • 조윤제 (경희대학교 의과대학 정형외과학교실) ;
  • 김강일 (경희대학교 의과대학 정형외과학교실) ;
  • 전영수 (경희대학교 의과대학 정형외과학교실) ;
  • 유기형 (경희대학교 의과대학 정형외과학교실) ;
  • 노준하 (경희대학교 의과대학 정형외과학교실) ;
  • 김영준 (경희대학교 의과대학 정형외과학교실) ;
  • 유명철 (경희대학교 의과대학 정형외과학교실)
  • Published : 2009.06.30

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Abstract

Purpose: This study evaluated the effect of antibiotic-loaded cement spacers on the treatment of infected hip arthroplasty. Materials and Methods: Twenty-one patients, twenty-one cases that experienced infection after total hip arthroplasty, were treated with two-stage arthroplasty using antibiotic-loaded cement spacers between July 1995 and March 2005. The average age was 56.3 years (range, 36~84 years). The follow-up period was 7.2 years (range, 3~11.4 years). The period from the first operation to diagnosis of infection was 28 months (range, 1~49 months). Preoperative culture, Tc 99m scan or Gallium scan, intraoperative culture and biopsy were performed for the evaluation of infection. We postoperatively evaluated clinical and radiological outcomes, blood analysis including serologic study, complete blood cell count, differential count, erythrocyte sedimentation rate and C-reactive protein. Results: Of a total of 21cases, acetabular cup, femoral head and femoral stem were substituted in 10 cases (48%). Acetabular cup and femoral head were substituted in 11 cases (52%). Revision arthroplasty was performed in 19 cases, on average 11.9 months (range 2~31 months) after insertion of antibiotic-loaded cement spacers. Infection recurred in 1 case. In 18 cases, excluding the reinfected one, the average Harris hip score, 46.8 points (range, 35~72 points) preoperatively, improved to 89.5 points (range, 78~100 points) at last follow-up in the revision group. In 2 cases in which revision total hip arthroplasty was not performed, the Harris hip score was 53 points (range, 36~70 points) preoperatively, and 86 points (range,72~100 points) at last follow-up. Conclusion: The use of antibiotic-loaded cement spacers in two-stage arthroplasty is an effective method for management of infection, preserving joint function until performing revision arthroplasty. Preservation of the femoral stem should be considered in cases in which were fixed firmly and in cases which show no evidence of the spreading of infection to the distal part of the stem on Tc 99m scan or Gallium scan performed preoperatively.

목적: 인공 고관절 치환술 후 발생한 심부 감염증 환자에 있어서 항생제 혼합 시멘트 충전물을 이용한 술식의 치료 결과를 보고 하고자 한다. 대상 및 방법: 1995년 7월부터 2005년 3월까지 인공 고관절 치환술 후 감염된 인공 고관절로 판명되어 항생제 혼합 시멘트 충전물을 이용하여 치료받은 환자 중3년 이상 추시 가능하였던 21명, 21예를 대상으로 하였고 평균 연령은 56.3세 (범위, 36~84세)였다. 추시 기간은 평균 7.2년(범위, 3~11.4년)이며 첫 수술 후 감염의 진단까지는 평균 28개월(범위, 1~49개월)이었다. 수술 전 배양 검사 및 Tc 99m scan 또는 Gallium scan을 시행하였고, 수술 중 배양 검사 및 조직 검사, 수술 후 일반 혈액학 및 감별 혈액학, 적혈구 침강 속도 및 C-반응 단백수치, 임상적 및 방사선적 결과를 추시 하였다. 결과: 총 21예 중 비구 컵, 대퇴 골두 및 대퇴 스템 모두를 충전물로 대치한 경우가 10예(48%), 비구 컵과 인공 대퇴 골두만을 충전물로 대치한 경우가 11예(52%)였다. 재치환술은 항생제 혼합시멘트 충전물을 넣은 후 평균11.9개월(범위, 2~31개월)에 19예에서 시행하였으며 1예에서 감염이 재발하였다. 재 감염된 1예를 제외한18예의 해리스 고관절 점수는 술전 평균46.8점(범위, 35~72점)에서 최종 추시 시 평균 89.5점(범위, 78~100점) 이었다. 충전물이 남아있는 2예에서는 술전 평균 53점(범위, 36~70점)에서 최종 추시 시 평균 86점(범위, 72~100점)이었다. 결론: 항생제 혼합 시멘트 충전물을 이용한 단계적 고관절 치환술은 재치환술까지 관절 기능을 보존하면서 감염을 효과적으로 치료할 수 있는 방법으로 사료되며, 수술 전 Tc 99m scan이나 Gallium scan을 실시하여 대퇴 스템 부위 감염의 증거가 없으며 안정적으로 고정된 대퇴 스템의 경우에는 가급적 보존하는 것이 좋을 것으로 사료된다.

Keywords

References

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