The role of acetabular cement augmentation in 2-stage revision arthroplasty for prosthetic joint infection of the hip.

Autor: Raspanti F; Department of Orthopaedic Surgery, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno A Ripoli, FI, Italy., Zanna L; Department of Orthopaedic Surgery, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno A Ripoli, FI, Italy. luigizanna90@gmail.com., Sangaletti R; Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, 25124, Italy., Innocenti M; Department of General Orthopaedics, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, Florence, 50139, Italy., Benazzo F; Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, 25124, Italy.; IUSS Istituto Universitario di Studi Superiori, Pavia, Italy., Civinini R; Department of General Orthopaedics, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, Florence, 50139, Italy., Mugnaini M; Department of Orthopaedic Surgery, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno A Ripoli, FI, Italy.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Dec; Vol. 144 (12), pp. 5251-5260. Date of Electronic Publication: 2024 Sep 11.
DOI: 10.1007/s00402-024-05541-w
Abstrakt: Introduction: In the treatment of chronic prosthetic joint infection (PJI) of the hip, two-stage exchange arthroplasty is commonly employed. Various spacer designs, including Hemi-Spacers and Articulating Spacers, are utilized during this process. However, these spacers are associated with a high rate of mechanical complications and pose a risk of progressive bone loss. This study aims to compare these two types of spacers in terms of mechanical complications, center of rotation (COR) restoration, and preservation of acetabular bone stock.
Materials and Methods: From 2019 to 2022, patients who underwent two-stage exchange arthroplasty for hip PJI across three hospitals were retrospectively reviewed. Data including demographic, clinical, and microbiological information were collected. Radiographic imaging was analyzed to measure acetabular bone erosion, COR, and periacetabular bone resected. Additionally, the average surgical time in the first and second stages, mechanical complications, and the mean duration of the inter-stage period were recorded.
Results: Forty patients were divided into two groups: Group A (Articulating Spacer, n = 23) received a preformed femur spacer with acetabular cement augmentation, while Group B (Hemi-Spacer, n = 17) received a preformed femur spacer alone. Acetabular cement augmentation slightly prolonged the first stage but facilitated a faster second stage during subsequent reimplantation. Spacer dislocation rates were 8.7% in Group A and 17.6% in Group B during the interstage period. Radiographic analysis revealed a statistically significant greater degree of acetabular erosion in Group B. A significant difference in Vertical-COR differential was observed, with a more proximalized revision cup compared to the primary cup in Group B, and Horizontal-COR values closer to the native hip in Group A.
Conclusions: Dynamic spacers with acetabular cement augmentation help preserve peri-acetabular bone stock and prevent progression of acetabular bone erosion during the inter-stage period. Additionally, these spacers reduce the dislocation rates, making reimplantation easier and leading to better restoration of hip biomechanics during the second procedure.
Competing Interests: Declarations. Ethical approval: The authors certify that the institution approved the human protocol for this investigation; all investigations were conducted in conformity with ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. All patients have given their informed consent for participation and there is no financial interest to report. Consent for publication: Obtained. Conflict of interest: All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Therefore, no benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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