Staged Revision Hip Arthroplasty With Femoral Impaction Bone Grafting for Prosthetic Joint Infections: Radiostereometric Analyses and Clinical Outcomes at Minimum 5-Year Follow-Up.

Autor: Bunting AC; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia., Costi K; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia., Chimutengwende-Gordon M; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia., Callary SA; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia., Pannach S; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia., Nelson R; Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, South Australia., Howie DW; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia., Solomon LB; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2023 Dec; Vol. 38 (12), pp. 2716-2723.e1. Date of Electronic Publication: 2023 Jun 13.
DOI: 10.1016/j.arth.2023.06.003
Abstrakt: Background: There are ongoing concerns regarding the use of bone graft following prosthetic joint infection and subsequent implant subsidence. The aim of this study was to determine whether the use of a cemented stem combined with femoral impaction bone grafting (FIBG) at second stage revision for infection results in stable femoral stem fixation, determined by accurate methods, and good clinical results.
Methods: A prospective cohort of 29 patients underwent staged revision total hip arthroplasty for infection using an interval prosthesis followed by FIBG at the final reconstruction. The mean follow-up was 89 months (range, 8 to 167 months). Femoral implant subsidence was measured with radiostereometric analysis. Clinical outcomes included the Harris Hip Score, Harris Pain score and Société Internationale de Chirurgie Orthopédique et de Traumatologie activity scores.
Results: At 2-years follow-up the median stem subsidence relative to femur was -1.36 mm (range, -0.31 to -4.98), while the cement subsidence relative to femur was -0.05 mm (range, 0.36 to -0.73). At 5-years follow-up, the median stem subsidence relative to femur was -1.89 mm (range, -0.27 to -6.35), while the cement subsidence relative to femur was -0.06 mm (range, 0.44 to -0.55). There were 25 patients who were confirmed infection-free after the second stage revision with FIBG. The median Harris Hip Score improved from 51 pre-operatively to 79 at 5 years (P = .0130), and Harris Pain score from 20 to 40 (P = .0038).
Conclusions: Stable femoral component fixation can be achieved with FIBG when reconstructing the femur after revision for infection without compromising infection cure rates and patient-reported outcomes.
(Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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