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Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections
PURPOSE: A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the “gold standard” for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplanta...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Hip Society
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10020733/ https://www.ncbi.nlm.nih.gov/pubmed/36937214 http://dx.doi.org/10.5371/hp.2023.35.1.32 |
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author | Fiore, Michele Rondinella, Claudia Paolucci, Azzurra Morante, Lorenzo De Paolis, Massimiliano Sambri, Andrea |
author_facet | Fiore, Michele Rondinella, Claudia Paolucci, Azzurra Morante, Lorenzo De Paolis, Massimiliano Sambri, Andrea |
author_sort | Fiore, Michele |
collection | PubMed |
description | PURPOSE: A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the “gold standard” for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer. MATERIALS AND METHODS: A retrospective review of 64 consecutive patients was conducted: 34 underwent two-stage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays. RESULTS: Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9; P<0.001). CONCLUSION: The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure. |
format | Online Article Text |
id | pubmed-10020733 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Korean Hip Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-100207332023-03-18 Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections Fiore, Michele Rondinella, Claudia Paolucci, Azzurra Morante, Lorenzo De Paolis, Massimiliano Sambri, Andrea Hip Pelvis Original Article PURPOSE: A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the “gold standard” for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer. MATERIALS AND METHODS: A retrospective review of 64 consecutive patients was conducted: 34 underwent two-stage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays. RESULTS: Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9; P<0.001). CONCLUSION: The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure. Korean Hip Society 2023-03 2023-03-06 /pmc/articles/PMC10020733/ /pubmed/36937214 http://dx.doi.org/10.5371/hp.2023.35.1.32 Text en Copyright © 2023 by Korean Hip Society https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Fiore, Michele Rondinella, Claudia Paolucci, Azzurra Morante, Lorenzo De Paolis, Massimiliano Sambri, Andrea Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections |
title | Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections |
title_full | Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections |
title_fullStr | Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections |
title_full_unstemmed | Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections |
title_short | Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections |
title_sort | functional outcome after reimplantation in patients treated with and without an antibiotic-loaded cement spacers for hip prosthetic joint infections |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10020733/ https://www.ncbi.nlm.nih.gov/pubmed/36937214 http://dx.doi.org/10.5371/hp.2023.35.1.32 |
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