The Fate of Spacers in the Treatment of Periprosthetic Joint Infection
The Fate of Spacers in the Treatment of Periprosthetic Joint Infection
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DOI：
10.2106/jbjs.n.00958
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发表时间：
2015-09-16
影响因子：
5.3
通讯作者：
Parvizi, Javad
中科院分区：
文献类型：
--
作者：
Gomez, Miguel M.;Tan, Timothy L.;Parvizi, Javad
背景：二期置换关节成形术仍然是治疗假体周围关节感染的首选方法。本研究的目的是探讨切除关节成形术和插入spacer.Methods的假体周围关节感染的临床过程：我们的机构数据库被用来确定504例假体周围关节感染（326膝关节和178髋关节）切除关节成形术和间隔插入的一部分，两个阶段的交换关节成形术。回顾病人的图表进行提取相关的信息，本研究的目标，包括切除arthroplasty.Results后的临床过程的细节：初始间隔植入后的平均随访时间为56.2个月。504例中417例（82.7%）关节再植。在这417例病例中，329例（78.9%）至少随访1年，其中81.4%成功治疗。从切除关节成形术到再植入的平均持续时间为4.2个月（范围：0.7至131.7个月）。504个关节中有60个（11.9%）需要临时更换垫片。在87例未接受再植入的病例中，6例（6.9%）需要截肢，5例（5.7%）接受Girdlestone手术，4例（4.6%）接受关节融合术，72例（82.8%）接受融合器保留。36例患者死亡的interstage.Conclusions：普遍认为，两阶段交换关节置换术进行了高成功率的假体周围关节感染的根除可能需要重新检查。由于各种原因，接受两阶段手术的第一阶段的相当多的患者没有接受后续的再植入术，或者在此期间需要额外的融合器更换。关于二期置换成功的报告应说明这些患者和从未接受再植的患者的死亡率。
Background: Two-stage exchange arthroplasty remains the preferred method to treat periprosthetic joint infection. The aim of this study was to investigate the clinical course of periprosthetic joint infection following resection arthroplasty and insertion of a spacer.Methods: Our institutional database was used to identify 504 cases of periprosthetic joint infection (326 knees and 178 hips) treated with resection arthroplasty and spacer insertion as part of a two-stage exchange arthroplasty. A review of the patient charts was performed to extract information relevant to the objectives of this study that included the details of the clinical course following resection arthroplasty.Results: The mean follow-up duration after initial spacer implantation was 56.2 months. Reimplantation occurred in the joints of 417 (82.7%) of 504 cases. Of these 417 cases, 329 (78.9%) had a minimum one-year follow-up, and 81.4% of these had successful treatment. The mean duration from resection arthroplasty to reimplantation was 4.2 months (range, 0.7 to 131.7 months). Sixty (11.9%) of the 504 joints required interim spacer exchange(s). Of the eighty-seven cases that did not undergo reimplantation, six (6.9%) required amputation, five (5.7%) underwent a Girdlestone procedure, four (4.6%) underwent arthrodesis, and seventy-two (82.8%) underwent spacer retention. Thirty-six patients died in the interstage period.Conclusions: The commonly held belief that two-stage exchange arthroplasty carries a high success rate for the eradication of periprosthetic joint infection may need to be reexamined. A considerable number of patients undergoing the first stage of a two-stage procedure do not undergo a subsequent reimplantation for a variety of reasons or require an additional spacer exchange in the interim. Reports on the success of two-stage exchange should account for the mortality of these patients and for patients who never undergo reimplantation.