Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지

Staged Revision of Infected Hip Arthroplasty Using an Antibiotics-Loaded Intra-Articular Cement Spacer with Retention of the Stem

대퇴 주대 보존 후 관절 내 항생제 혼합 시멘트 충전물을 이용한 인공 고관절 감염에 대한 단계적 재치환술

  • Sung, Yerl-Bo (Department of Orthopedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University) ;
  • Oh, Jong-Seok (Department of Orthopedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University)
  • 성열보 (인제대학교 의과대학 상계백병원 정형외과학교실) ;
  • 오종석 (인제대학교 의과대학 상계백병원 정형외과학교실)
  • Published : 2010.03.31
⟨ Previous Next ⟩

Abstract

Purpose: When the femoral stem was well fixed in patients with a deep prosthetic hip infection, the authors performed a two-stage revision procedure using antibiotic-loaded cement spacers (ALCS) without removal of the stem, and the efficacy of this treatment was assessed. Materials and Methods: For 12 cases of infected hip arthroplasties, a two-stage procedure was performed, and the patients were followed up for over 2 years. After the acetabular component and head was removed, debridement was done. The molded ALCS was inserted. Revision was then performed after eradication of the infection. The results were analyzed, including the changes in the clinical manifestation, the radiologic findings, the laboratory results, the functional score and the complications. Results: Of all 12 cases, the two-stage revision arthroplasty using an ALCS with retention of the stem was performed in 11 cases (92%), on an average of 66 days (range: 40~152 days). In the 11 revised cases, there was no evidence of recurrence of infection. In the 11 cases, the mean Harris hip score improved from 40.1 points preoperatively to 91.8 points at last the follow-up. The mean WOMAC score improved from 41.8 points preoperatively to 81 points at the last follow-up. The mean Harris hip score was 85.3 points and the WOMAC score was 72.4 points during the ALCS insertion- period. Conclusion: For the case of a perioprosthetic hip infection with a well-fixed femoral stem, two-staged revision using an ALCS without stem removal could be an alternative method in terms of effective infection control and preservation of the joint function.

목적: 인공고관절 치환술 후에 발생한 심부 감염에 대해 항생제 혼합 시멘트 충전물을 이용한 감염 조절 후 2단계 고관절 치환술을 시행한 예에서 대퇴 주대를 제거하지 않고 치료한 결과 및 효용성에 대해 알아보고자 하였다. 대상 및 방법: 2001년 12월 1일부터 2007년 6월 30일까지 항생제 혼합 시멘트 충전물로 치료한 인공고관절 중심부 감염이 확인되었으나 대퇴 삽입물은 안정적으로 고정되어 있어 주대를 제거하지 않고 치료하여 최소 2년 이상 추시가 가능했던 12예를 대상으로 하였다. 수술 전 후 임상 증상, 방사선학적 소견, ESR, CRP, Harris 고관절 점수, WOMAC 점수 및 충전물 삽입 기간 중 환자의 기능과 합병증을 분석하였다. 결과: 평균 66일(40~152일)에 재치환술을 시행하였다. Harris 고관절 점수는 술 전 평균 40.1점, 시멘트 충전물 삽입 후 85.3점, 최종 추시에서 91.8점으로 향상되었으며 WOMAC 점수는 술전 평균 41.8점, 시멘트 충전물 삽입 후 72.4점, 최종 추시에서 81점으로 호전되었다. 합병증으로 1예의 충전물 탈구가 있었고 1예는 감염이 지속되어 주대를 제거하여 치료하였다. 결론: 고관절에 발생한 심부 감염의 치료에 있어 대퇴 삽입물의 해리소견 없이 잘 고정되어 있는 경우 대퇴 주대를 보존하면서 항생제 혼합 시멘트 충전물을 이용하여 2단계 재치환술을 시행하는 방법도 고려해볼 만한 치료방법의 하나로 사료된다.

Keywords

References

  1. Canner GC, Steinberg ME, Heppenstall BR, Richard B. The infected hip after total hip arthroplasty. J Bone Joint Surg Am. 1984;66:1393-9.
  2. Phillips JE, Crane TP, Noy M, Elliott TS, Grimer RJ. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br. 2006;88:943-8. https://doi.org/10.1302/0301-620X.88B7.17150
  3. Volin SJ, Hinrichs SH, Garvin KL. Two-stage reimplantation of total joint infections: a comparison of resistant and nonresistant organisms. Clin Orthop Relat Res. 2004;427:94-100. https://doi.org/10.1097/01.blo.0000143559.34143.3d
  4. Deshmukh RG, Thevarajan K, Kok CS, Sivapathasundaram N, George SV. An intramedullary cement spacer in total hip arthroplasty. J Arthroplasty. 1998;13:197-9. https://doi.org/10.1016/S0883-5403(98)90099-7
  5. Garvin KL, Hanssen AD. Infection after total hip arthroplasty. Past, present, and future. J Bone Joint Surg Am. 1995;77:1576-88.
  6. Booth RE, Lotke PA. The results of spacer block technique in revision of infected total knee arthroplasty. Clin Orthop Relat Res. 1989;248:57-60.
  7. Ivarsson I, Wahlstrom O, Djerf K, Jacobsson SA. Revision of infected hip replacement. Two-stage procedure with a temporary gentamicin spacer. Acta Orthop Scand. 1994; 65:7-8. https://doi.org/10.3109/17453679408993707
  8. Lord GA, Hardy JR, Kummer FJ. An uncemented total hip replacement: experimental study and review of 300 madreporique arthroplasties. Clin Orthop Relat Res. 1979;141:2-16.
  9. Fitzgerald RH Jr, Nolan DR, Ilstrup DM, Van Scoy RE, Washington JA 2nd, Coventry MB. Deep wound sepsis following total hip arthroplasty. J Bone Joint Surg Am. 1977;59:847-55.
  10. Lonner JH, Desai P, Dicesare PE, Steiner G, Zuckerman JD. The reliability of analysis of intraoperative frozen sections for identifying active infection during revision hip or knee arthroplasty. J Bone Joint Surg Am. 1996;78: 1553-8.
  11. Mirra JM, Amstutz HC, Matos M, Gold R. The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res. 1976;117:221-40.
  12. Buchholz HW, Elson RA, Engelbrecht E, Lodenkamper H, Rottger J, Siegel A. Management of deep infection of total hip replacement. J Bone Joint Surg Br. 1981;63:342-53.
  13. Callaghan JJ, Katz RP, Johnston RC. One-stage revision surgery of the infected hip. A minimum 10-year follow up study. Clin Orthop Relat Res. 1999;369:139-43. https://doi.org/10.1097/00003086-199912000-00014
  14. Bittar ES, Petty W. Girdlestone arthroplasty for infected total hip arthroplasty. Clin Orthop Relat Res. 1982;170:83-7.
  15. Antii-Poikia I, Santavirta S, Konttinen YT, Honkanen V. Outcome of the infected hip arthroplasty. A retrospective study of 36 patients. Acta Orthop Scand. 1989;60:670-5. https://doi.org/10.3109/17453678909149600
  16. Balderston RA, Hiller WD, Iannotti JP, et al. Treatment of the septic hip with total hip arthroplasty. Clin Orthop Relat Res. 1987;221:231-7.
  17. Lieberman JR, Callaway GH, Salvati EA, Pellicci PM, Brause BD. Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. Clin Orthop Relat Res. 1994;301:205-12.
  18. Salvati EA, Chekofsky KM, Brause BD, Wilson PD Jr. Reimplantation in infection: a 12-year experience. Clin Orthop Relat Res. 1982;170:62-75.
  19. Younger AS, Duncan CP, Masri BA. Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis. J Bone Joint Surg Am. 1998;80:60-9.
  20. Kendall RW, Masri BA, Duncan CP, Beauchamp CP, McGraw RW, Bora B. Temporary antibiotic loaded acrylic hip replacement: a novel method for management of the infected THA. Semin Arthroplasty. 1994;5:171-7.
  21. Sanchez-Sotelo J, Berry DJ, Hanssen AD, Cabanela ME. Midterm to long-term followup of staged reimplantation for infected hip arthroplasty. Clin Orthop Relat Res. 2009; 467:219-24. https://doi.org/10.1007/s11999-008-0480-4
  22. Cordero J, Munuera L, Folgueira MD. Influence of bacterial strains on bone infection. J Orthop Res. 1996; 14:663-7. https://doi.org/10.1002/jor.1100140423
  23. Struhl S, Harwin SF, Stern RE, Kulick RG. Infected uncemented hip arthroplasty. Preserving the femoral stem with a two- stage revision procedure. Orthopaedic Rev. 1989;18:707-12.
  24. Yoon TR, Rowe SM, Park CH, Jung SN. Treatment of infected uncemented total hip arthroplasty: two-stage revision procedure by preserving well-fixed femoral components in four cases. J Korean Orthop Assoc. 2000; 35:467-71.
  25. Gristina AG, Naylor PT, Webb LX. Molecular mechanisms in musculoskeletal sepsis: the race for the surface. Instr Course Lect. 1990;39:471-82.