Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Treatment of Infected Hip Arthroplasty with Antibiotic-Impregnated Calcium Sulfate Cement

항생제 혼합 calcium sulfate cement를 이용한 감염된 인공 고관절 치환술의 치료

  • Park, Bong-Ju (Department of Orthopedic Surgery, Gwangju Veterans Hospital) ;
  • Cho, Hong-Man (Department of Orthopedic Surgery, Gwangju Veterans Hospital) ;
  • Sim, Ju-Hyun (Department of Orthopedic Surgery, Gwangju Veterans Hospital) ;
  • Choi, Hyun-Ju (Department of Internal Medicine, Hankook Hospital)
  • 박봉주 (광주 보훈병원 정형외과) ;
  • 조홍만 (광주 보훈병원 정형외과) ;
  • 심주현 (광주 보훈병원 정형외과) ;
  • 최현주 (대전 한국병원 내과)
  • Published : 2011.12.31
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Abstract

Purpose: To analyze the effectiveness of inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin after debridement of an acute-immediate stage infected hip arthroplasty. Materials and Methods: Between 2002 and 2008, the cases of 13 patients with documented acute-immediate stage infections of hip arthroplasty were reviewed and followed for at least two years postoperatively (average 4.3 years). The preoperative and postoperative clinical and radiologic findings and blood laboratory work of the cases were checked. All cases were performed through retention of the implant and massive debridement and saline irrigation. Next, vancomycin-impregnated calcium sulfate cement beads were inserted. Results: After the first operation, the average interval to wait before performing a second operation was 27.7 days (17~37 days). During the second operation, the erythrocyte sediment rate and C-reactive protein were 150.97 mm/hr (34.6~339.7 mm/hr) and 76.4 mg/L (41~132 mg/L), respectively. Infectious organisms were cultured and isolated. There were 5 cases of Methicillin-resistant Staphylococcus aureus (MRSA). In addition, the results of an antibiotics sensitivity test revealed 8 cases of Vancomycin and 5 cases of 3rd generation Cephalosporin. Radiologic results showed 10 cases with a stable fixation on the last follow-up (femoral stem), and 1 case of hip joint space narrowing, called acetabular erosion. Conclusion: Inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin proved to be a useful treatment for an acute immediate infection of hip arthroplasty.

목적: 인공 고관절 치환술후 급성 전격성 감염에 대하여 변연절제술과 황산 칼슘 시멘트를 이용한 염주알 삽입술을 시행하고 그 결과를 분석하였다. 대상 및 방법: 2002년부터 2008년까지 인공 관절 치환술 후 전격성 급성 감염이 발생한 환자 13예를 대상으로 2년 이상 추시 하였고, 평균 추시 기간은 4.3년 이었다. 철저한 변연 절제술과 세척술 후 황산 칼슘 시멘트 염주알을 삽입하였고 첫 수술과 2차 수술까지의 기간과 임상병리학적, 방사선학적 결과를 평가 하였다. 결과: 일차 수술 후 2차 수술까지의 기간은 평균 27.7일(17~37일) 2차 수술 당시의 평균 적혈구 침강 속도와 C-반응성 단백질은 각각 평균 150.97 mm/hr(34.6~339.7 mm/hr)과 76.4 mg/L(41~132 mg/L)였고, 배양된 균주는 MRSA 5예 등 이었고, 항생제 감수성 검사의 결과는 Vancomycin 8예 등 이었다. 방사선학적 결과로 대퇴 스템은 10예에서 안정적인 고정을, 비구부는 1예에서 관절 간격의 협소와 비구부 미란으로 추정되었다. 결론: 황산 칼슘 시멘트를 이용한 항생제 내재형 시멘트 염주알을 이용한 치료는 인공 고관절 치환술 후 발생한 급성 전격성 감염증에 대하여 변연 절제술과 더불어 시행할 수 있는 유용한 시술방법 중 하나로 생각된다.

Keywords

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Cited by

  1. Long-Term Clinical Outcome of Two Stage Revision Surgery for Infected Hip Arthroplasty Using Cement Spacer vol.49, pp.5, 2011, https://doi.org/10.4055/jkoa.2014.49.5.355