Hip & pelvis

  • 제35권1호
  • /
  • Pages.32-39
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  • 2023
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  • 2287-3260(pISSN)
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  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
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Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections

  • Michele Fiore (Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna) ;
  • Claudia Rondinella (Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna) ;
  • Azzurra Paolucci (Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna) ;
  • Lorenzo Morante (Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna) ;
  • Massimiliano De Paolis (Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna) ;
  • Andrea Sambri (Orthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna)
  • 투고 : 2022.09.27
  • 심사 : 2022.11.14
  • 발행 : 2023.03.31
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초록

Purpose: A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the "gold standard" for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer. Materials and Methods: A retrospective review of 64 consecutive patients was conducted: 34 underwent two-stage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays. Results: Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9; P<0.001). Conclusion: The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure.

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참고문헌

  1. Cabrita HB, Croci AT, Camargo OP, Lima AL. Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer. Clinics (Sao Paulo). 2007;62:99-108. https://doi.org/10.1590/s1807-59322007000200002 
  2. Diamond OJ, Masri BA. Articulating antibiotic impregnated spacers in prosthetic joint infections: where do we stand? Int J Surg. 2018;54(Pt B):345-50. https://doi.org/10.1016/j.ijsu.2017.07.044 
  3. Sandiford NA, Duncan CP, Garbuz DS, Masri BA. Two-stage management of the infected total hip arthroplasty. Hip Int. 2015;25:308-15. https://doi.org/10.5301/hipint.5000265 
  4. Erivan R, Lecointe T, Villatte G, Mulliez A, Descamps S, Boisgard S. Complications with cement spacers in 2-stage treatment of periprosthetic joint infection on total hip replacement. Orthop Traumatol Surg Res. 2018;104:333-9. https://doi.org/10.1016/j.otsr.2017.11.016 
  5. Leunig M, Chosa E, Speck M, Ganz R. A cement spacer for two-stage revision of infected implants of the hip joint. Int Orthop. 1998;22:209-14. https://doi.org/10.1007/s002640050244 
  6. Romano CL, Romano D, Meani E, Logoluso N, Drago L. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study. BMC Infect Dis. 2011;11:129. https://doi.org/10.1186/1471-2334-11-129 
  7. Sambri A, Maso A, Storni E, et al. Is sonication of antibiotic-loaded cement spacers useful in two-stage revision of prosthetic joint infection? J Microbiol Methods. 2019;156:81-4. https://doi.org/10.1016/j.mimet.2018.12.006 
  8. Sambri A, Fiore M, Rondinella C, et al. Mechanical complications of hip spacers: a systematic review of the literature. Arch Orthop Trauma Surg. Published online Apr 12, 2022; https://doi.org/10.1007/s00402-022-04427-z 
  9. Hipfl C, Carganico T, Leopold V, Perka C, Muller M, Hardt S. Two-stage revision total hip arthroplasty without spacer placement: a viable option to manage infection in patients with severe bone loss or abductor deficiency. J Arthroplasty. 2021;36:2575-85. https://doi.org/10.1016/j.arth.2021.02.040 
  10. Marczak D, Synder M, Sibinski M, Polguj M, Dudka J, Kowalczewski J. Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer. Int Orthop. 2017;41:2253-8. https://doi.org/10.1007/s00264-017-3500-8 
  11. Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33:1309-14.e2. https://doi.org/10.1016/j.arth.2018.02.078 
  12. Sambri A, Fiore M, Tedeschi S, De Paolis M. The need for multidisciplinarity in modern medicine: an insight into orthopaedic infections. Microorganisms. 2022;10:756. https://doi.org/10.3390/microorganisms10040756 
  13. Sambri A, Cadossi M, Giannini S, et al. Is treatment with dithiothreitol more effective than sonication for the diagnosis of prosthetic joint infection? Clin Orthop Relat Res. 2018;476:137-45. https://doi.org/10.1007/s11999.0000000000000060 
  14. Sambri A, Maso A, Storni E, et al. Sonication improves the diagnosis of megaprosthetic infections. Orthopedics. 2019;42:28-32. https://doi.org/10.3928/01477447-20181010-06 
  15. Ibrahim DA, Fernando ND. Classifications in brief: the Paprosky classification of femoral bone loss. Clin Orthop Relat Res. 2017;475:917-21. https://doi.org/10.1007/s11999-016-5012-z 
  16. Telleria JJ, Gee AO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res. 2013;471:3725-30. https://doi.org/10.1007/s11999-013-3264-4 
  17. Tan TL, Kheir MM, Rondon AJ, Parvizi J, George J, Higuera CA, et al. Determining the role and duration of the "antibiotic holiday" period in periprosthetic joint infection. J Arthroplasty. 2018;33:2976-80. https://doi.org/10.1016/j.arth.2018.04.019 
  18. Fillingham YA, Della Valle CJ, Suleiman LI, et al. Definition of successful infection management and guidelines for reporting of outcomes after surgical treatment of periprosthetic joint infection: from the workgroup of the musculoskeletal infection society (MSIS). J Bone Joint Surg Am. 2019;101:e69. https://doi.org/10.2106/JBJS.19.00062 
  19. Harris IE, Leff AR, Gitelis S, Simon MA. Function after amputation, arthrodesis, or arthroplasty for tumors about the knee. J Bone Joint Surg Am. 1990;72:1477-85.  https://doi.org/10.2106/00004623-199072100-00008
  20. Mabry TM, Hanssen AD. Articulating antibiotic spacers: a matter of personal preference. Orthopedics. 2007;30:783-5. https://doi.org/10.3928/01477447-20070901-02 
  21. Bloomfield MR, Klika AK, Barsoum WK. Antibiotic-coated spacers for total hip arthroplasty infection. Orthopedics. 2010;33:649. https://doi.org/10.3928/01477447-20100722-21 
  22. Gramlich Y, Hagebusch P, Faul P, Klug A, Walter G, Hoffmann R. Two-stage hip revision arthroplasty for periprosthetic joint infection without the use of spacer or cemented implants. Int Orthop. 2019;43:2457-66. https://doi.org/10.1007/s00264-019-04297-y 
  23. Jung J, Schmid NV, Kelm J, Schmitt E, Anagnostakos K. Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci. 2009;6:265-73. https://doi.org/10.7150/ijms.6.265 
  24. Garvin KL, Hanssen AD. Infection after total hip arthroplasty. Past, present, and future. J Bone Joint Surg Am. 1995;77:1576-88. https://doi.org/10.2106/00004623-199510000-00015 
  25. Pagnano MW, Trousdale RT, Hanssen AD. Outcome after reinfection following reimplantation hip arthroplasty. Clin Orthop Relat Res. 1997;(338):192-204. https://doi.org/10.1097/00003086-199705000-00026 
  26. Gomez MM, Tan TL, Manrique J, Deirmengian GK, Parvizi J. The fate of spacers in the treatment of periprosthetic joint infection. J Bone Joint Surg Am. 2015;97:1495-502. https://doi.org/10.2106/JBJS.N.00958 
  27. George J, Miller EM, Curtis GL, et al. Success of two-stage reimplantation in patients requiring an interim spacer exchange. J Arthroplasty. 2018;33(7S):S228-32. https://doi.org/10.1016/j.arth.2018.03.038 
  28. Jahoda D, Sosna A, Landor I, Vavrik P, Pokorny D, Hudec T. [Two-stage reimplantation using spacers--the method of choice in treatment of hip joint prosthesis-related infections. Comparison with methods used from 1979 to 1998]. Acta Chir Orthop Traumatol Cech. 2003;70:17-24. Czech. 
  29. Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am. 2004;86:1989-97.  https://doi.org/10.2106/00004623-200409000-00018
  30. Cancienne JM, Werner BC, Bolarinwa SA, Browne JA. Removal of an infected total hip arthroplasty: risk factors for repeat debridement, long-term spacer retention, and mortality. J Arthroplasty. 2017;32:2519-22. https://doi.org/10.1016/j.arth.2017.03.018 
  31. Wang Q, Goswami K, Kuo FC, Xu C, Tan TL, Parvizi J. Two-stage exchange arthroplasty for periprosthetic joint infection: the rate and reason for the attrition after the first stage. J Arthroplasty. 2019;34:2749-56. https://doi.org/10.1016/j.arth.2019.06.021 
  32. Klouche S, Leonard P, Zeller V, et al. Infected total hip arthroplasty revision: one- or two-stage procedure? Orthop Traumatol Surg Res. 2012;98:144-50. https://doi.org/10.1016/j.otsr.2011.08.018 
  33. Leonard HA, Liddle AD, Burke O, Murray DW, Pandit H. Single- or two-stage revision for infected total hip arthroplasty? A systematic review of the literature. Clin Orthop Relat Res. 2014;472:1036-42. https://doi.org/10.1007/s11999-013-3294-y 
  34. Kunutsor SK, Whitehouse MR, Lenguerrand E, Blom AW, Beswick AD; INFORM Team. Re-infection outcomes following one- and two-stage surgical revision of infected knee prosthesis: a systematic review and meta-analysis. PLoS One. 2016;11:e0151537. https://doi.org/10.1371/journal.pone.0151537 
  35. Marczak D, Synder M, Sibinski M, Wasko M, Polguj M, Kowalczewski J. Comparison of patients treated with or without a spacer in two stage revision hip arthroplasty for periprosthetic joint infection. J Infect. 2016;73:520-2. https://doi.org/10.1016/j.jinf.2016.09.006 
  36. Castellanos J, Flores X, Llusa M, Chiriboga C, Navarro A. The Girdlestone pseudarthrosis in the treatment of infected hip replacements. Int Orthop. 1998;22:178-81. https://doi.org/10.1007/s002640050236 
  37. Alexeeff M, Mahomed N, Morsi E, Garbuz D, Gross A. Structural allograft in two-stage revisions for failed septic hip arthroplasty. J Bone Joint Surg Br. 1996;78:213-6.  https://doi.org/10.1302/0301-620X.78B2.0780213
  38. Charlton WP, Hozack WJ, Teloken MA, Rao R, Bissett GA. Complications associated with reimplantation after girdlestone arthroplasty. Clin Orthop Relat Res. 2003;(407):119-26. https://doi.org/10.1097/00003086-200302000-00019