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Lao HD, Liu D, Cheng B, Liu SL, Shuang F, Li H, Li L, Zhou JJ. Personalized digital simulation‑assisted acetabular component implantation in revision hip arthroplasty. Exp Ther Med 2024; 27:180. [PMID: 38515645 PMCID: PMC10952346 DOI: 10.3892/etm.2024.12468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/24/2024] [Indexed: 03/23/2024] Open
Abstract
The number of artificial total hip revision arthroplasties is increasing yearly in China, and >50% of these cases have acetabular defects. Accurately locating and quantifying the bone defect is one of the current challenges of this surgery. Thus, the objective of the present study was to simulate acetabular implantation with the aid of Mimics 17.0 software (Materialise NV) in patients with loosened acetabular prosthesis, to evaluate the 'ideal acetabular center' and the 'actual acetabular center' to guide the choice of prosthesis and surgical method. From January 2017 to June 2021, the present study included 10 hips from 10 patients [seven men (seven hips) and three women (three hips)]. In all patients, the Mimics software was applied to simulate the dislocation of the femoral prosthesis and acetabular prosthesis implantation before surgery; calculate the height difference between the 'ideal acetabular center' and the 'actual acetabular center' to assess the bone defect; confirm the size of the acetabular prosthesis, abduction angle, anteversion angle and bone coverage of the acetabular cup; and measure the intraoperative bleeding and postoperative follow-up Harris score of the hip joint. After statistical analysis, the present study revealed that digital simulation assistance could improve the accuracy of hip revision acetabular prosthesis implantation, reduce postoperative shortening of the affected limb, especially for surgeons with relatively little experience in hip revision surgery, and greatly reduce the occurrence of complications such as hip dislocation because of poor postoperative prosthesis position.
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Affiliation(s)
- Hong-Da Lao
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
| | - Da Liu
- Department of Orthopedics, General Hospital of Western Theater Command, Chengdu, Sichuan 610038, P.R. China
| | - Bin Cheng
- Second Department of Orthopedics, The 92962 Military Hospital, Guangzhou, Guangdong 510000, P.R. China
| | - Shu-Ling Liu
- Jiangxi Institute of Scientific and Technical Information, Nanchang, Jiangxi 335001, P.R. China
| | - Feng Shuang
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
| | - Hao Li
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
| | - Lei Li
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
| | - Jiang-Jun Zhou
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
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Carender CN, Perry KI, Sierra RJ, Trousdale RT, Berry DJ, Abdel MP. Modular fluted tapered stems in two-stage reimplantation of previously infected total hip arthroplasties. Bone Joint J 2024; 106-B:125-132. [PMID: 38688510 DOI: 10.1302/0301-620x.106b5.bjj-2023-0788.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Uncemented implants are now commonly used at reimplantation of a two-stage revision total hip arthoplasty (THA) following periprosthetic joint infection (PJI). However, there is a paucity of data on the performance of the most commonly used uncemented femoral implants - modular fluted tapered (MFT) femoral components - in this setting. This study evaluated implant survival, radiological results, and clinical outcomes in a large cohort of reimplantation THAs using MFT components. Methods We identified 236 reimplantation THAs from a single tertiary care academic institution from September 2000 to September 2020. Two designs of MFT femoral components were used as part of an established two-stage exchange protocol for the treatment of PJI. Mean age at reimplantation was 65 years (SD 11), mean BMI was 32 kg/m2 (SD 7), and 46% (n = 109) were female. Mean follow-up was seven years (SD 4). A competing risk model accounting for death was used. Results The 15-year cumulative incidence of any revision was 24%. There were 48 revisions, with the most common reasons being dislocation (n = 25) and infection (n = 16). The 15-year cumulative incidence of any reoperation was 28%. Only 13 revisions involved the fluted tapered component (FTC), for a 15-year cumulative incidence of any FTC revision of 8%. Only two FTCs were revised for aseptic loosening, resulting in a 15-year cumulative incidence of FTC revision for aseptic loosening of 1%. Stem subsidence ≥ 5 mm occurred in 2% of unrevised cases. All stems were radiologically stable at most recent follow-up. Mean Harris Hip Score was 69 (SD 20) at most recent follow-up. Conclusion This series demonstrated that MFT components were durable and reliable in the setting of two-stage reimplantation THA for infection. While the incidence of aseptic loosening was very low, the incidence of any revision was 24% at 15 years, primarily due to dislocation and recurrent PJI.
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Affiliation(s)
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Cacciola G, Giustra F, Bosco F, Aprato A, De Meo F, Cavaliere P, Vezza D, Giachino M, Sabatini L, Massè A. Extended trochanteric osteotomy is a safe procedure in two-stage hip revision: a systematic review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2695-2702. [PMID: 36849679 PMCID: PMC10504093 DOI: 10.1007/s00590-023-03497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Extended trochanteric osteotomy (ETO) has proved to be an effective technique in complicated stem removal in femoral aseptic loosening or periprosthetic fracture. Debate remains about its safety in periprosthetic joint infection (PJI). The primary aim of this study is to analyze the ETO reinfection and union rate in two-stage hip revision. MATERIAL AND METHODS A systematic literature review was performed regarding all studies reporting ETO outcomes in the two-stage revision for hip PJI up to October 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. A literature search was conducted in the following databases: MEDLINE/EMBASE, Scopus, Web of Science, and Cochrane. Quality assessment of the articles was performed using the Methodological Index for Non-Randomized Studies. This systematic review was registered in the International Prospective Registry of Systematic Reviews. Patient demographic, clinical, and surgical data were collected. RESULTS This systematic review included and analyzed nine clinical studies with a total of 382 ETO PJI hips in two-stage revision. The overall ETO reinfection rate was 8.9% (34 hips), consistent with the reinfection rate after two-stage revision in patients without ETO. The overall ETO union rate was 94.8% (347 hips), comparable to the ETO union rate in non-septic patients. Compared between a group of patients with ETO PJI and a group of patients with non-PJI ETO, there were no significant differences in postoperative complications, both septic and aseptic, and for postoperative HHS. CONCLUSION ETO proved to be a safe and effective procedure in PJI revisions. It may be a viable option in challenging femoral stem removal during the two-stage hip revision in PJI. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco - ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco - ASL Città di Torino, Turin, Italy.
| | - Alessandro Aprato
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Federico De Meo
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Pietro Cavaliere
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Daniele Vezza
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Matteo Giachino
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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Bosco F, Cacciola G, Giustra F, Risitano S, Capella M, Vezza D, Barberis L, Cavaliere P, Massè A, Sabatini L. Characterizing recurrent infections after one-stage revision for periprosthetic joint infection of the knee: a systematic review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2703-2715. [PMID: 36867259 PMCID: PMC10504163 DOI: 10.1007/s00590-023-03480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/18/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) of the knee represents a severe complication after 1.5% to 2% of primary total knee replacement. Although two-stage revision was considered the gold-standard treatment for PJI of the knee, in the last decades, more studies reported the outcomes of one-stage revisions. This systematic review aims to assess reinfection rate, infection-free survival after reoperation for recurrent infection, and the microorganisms involved in both primary and recurrent infection. MATERIAL AND METHODS A systematic review of all studies reporting the outcome of one-stage revision for PJI of the knee up to September 2022, according to PRISMA criteria and AMSTAR2 guidelines, was performed. Patient demographics, clinical, surgical, and postoperative data were recorded. PROSPERO ID CRD42022362767. RESULTS Eighteen studies with a total of 881 one-stage revisions for PJI of the knee were analyzed. A reinfection rate of 12.2% after an average follow-up of 57.6 months was reported. The most frequent causative microorganism were gram-positive bacteria (71.1%), gram-negative bacteria (7.1%), and polymicrobial infections (8%). The average postoperative knee society score was 81.5, and the average postoperative knee function score was 74.2. The infection-free survival after treatment for recurrent infection was 92.1%. The causative microorganisms at reinfections differed significantly from the primary infection (gram-positive 44.4%, gram-negative 11.1%). CONCLUSION Patients who underwent a one-stage revision for PJI of the knee showed a reinfection rate lower or comparable to other surgical treatments as two-stage or DAIR (debridement, antibiotics, and implant retention). Reoperation for reinfection demonstrates a lower success compared to one-stage revision. Moreover, microbiology differs between primary infection and recurrent infection. Level of evidence Level IV.
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Affiliation(s)
- Francesco Bosco
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco - ASL Città di Torino, Piazza del Donatore di Sangue, 3, 10154, Turin, Italy
| | - Giorgio Cacciola
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco - ASL Città di Torino, Piazza del Donatore di Sangue, 3, 10154, Turin, Italy.
| | - Salvatore Risitano
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Marcello Capella
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Daniele Vezza
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Luca Barberis
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Pietro Cavaliere
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", 98100, Messina, Via Consolare Pompea, Italy
| | - Alessandro Massè
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
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Cacciola G, Giustra F, Bosco F, De Meo F, Bruschetta A, Cavaliere P. Two-stage revision in periprosthetic joint infection of the hip using a new intraoperatively molded articulating spacer design. J Clin Orthop Trauma 2023; 43:102223. [PMID: 37520268 PMCID: PMC10372186 DOI: 10.1016/j.jcot.2023.102223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/14/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose The treatment of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is still under debate. Two-stage exchange arthroplasty is the most common surgical procedure performed. This study analyzed a new functional articulating hip spacer called "Spaceflex" regarding the mechanical-related complications, the recurrent/persistent infection during the interval period, the overall infection-free survivorship after reimplantation, the overall complication/reoperation after reimplantation and the evaluation of patient-reported outcome measures (PROMs) at three intervals of time: before the first stage, during the interval period, and at the final follow-up after reimplantation. Methods A consecutive series of 56 patients with chronic hip PJI undergoing two-stage prosthetic revision using a new intraoperatively molded articulating hip spacer design implanted by the same experienced surgeons was examined from January 2017 to December 2021. The demographic and clinical characteristics of the included patients were analyzed. Specifically, PROMs before the first stage, during the interval period, and at the final follow-up after reimplantation and complications reported during the interval period and after reimplantation were examined. Results The new functional articulating hip spacer was characterized by a low mechanical complication rate (5.8%) and an overall two-stage procedure success rate of 90.6% at the last follow-up. PROMs improved with the spacer during the interval period and at the final follow-up. Furthermore, the reinfection rate was in line with other case series with different spacer designs. Finally, low postoperative complication rates after reimplantation have been demonstrated. Conclusions Two-stage revision performed with a modular articulating spacer allows patients to preserve satisfactory functional and quality-of-life outcomes in the postoperative period, with a low risk of mechanical complications and without increasing the reinfection rate.
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Affiliation(s)
- Giorgio Cacciola
- University of Turin, Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Fortunato Giustra
- University of Turin, Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino, ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- University of Turin, Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino, ASL Città di Torino, Turin, Italy
| | - Federico De Meo
- Istituto Ortopedico del Mezzogiorno d’Italia “Franco Scalabrino”, Via Consolare Pompea, 98100, Messina, Italy
| | - Antongiulio Bruschetta
- Istituto Ortopedico del Mezzogiorno d’Italia “Franco Scalabrino”, Via Consolare Pompea, 98100, Messina, Italy
| | - Pietro Cavaliere
- Istituto Ortopedico del Mezzogiorno d’Italia “Franco Scalabrino”, Via Consolare Pompea, 98100, Messina, Italy
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Cacciola G, Mancino F, Holzer LA, De Meo F, De Martino I, Bruschetta A, Risitano S, Sabatini L, Cavaliere P. Predictive Value of the C-Reactive Protein to Albumin Ratio in 30-Day Mortality after Hip Fracture in Elderly Population: A Retrospective Observational Cohort Study. J Clin Med 2023; 12:4544. [PMID: 37445579 DOI: 10.3390/jcm12134544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND C-reactive protein (CRP) to Albumin ratio (CAR) has been used in multiple clinical settings to predict early mortality. However, there is a lack of evidence on the predictive role of CAR in 30-day mortality after a hip fracture. The purpose of this study was to establish a potential association between CAR and 30-day mortality and to assess if the CAR Receiving Operating Characteristics curve (ROC) can be a reliable predictor of early mortality. METHODS We retrospectively reviewed the charts of 676 patients (>65 years) treated for hip fracture between 2006 and 2018. All hip fractures were included. Treatment strategies included closed reduction and internal fixation, open reduction and internal fixation, hemiarthroplasty, or total joint arthroplasty. Statistical analysis included T-test, Pearson correlation for CAR and other markers, ROC curves and area under the curve, Youden Model, and Odds Ratio. RESULTS The 30-day mortality rate analysis showed that higher preoperative levels of CAR were associated with higher early mortality. When analyzing the area under the ROC curve (AUROC) for 30-day mortality, the reported value was 0.816. The point of the ROC curve corresponding to 14.72 was considered a cut-off with a specificity of 87% and a sensibility of 40.8%. When analyzing values higher than 14.72, the 30-day mortality rate was 17.9%, whilst, for values lower than 14.72, the 30-day mortality rate was 1.8%. CONCLUSIONS Patients older than 65 years affected by a hip fracture with increased preoperative levels of CAR are associated with higher 30-day mortality. Despite a moderate sensibility, considering the low cost and the predictivity of CAR, it should be considered a standard predictive marker.
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Affiliation(s)
- Giorgio Cacciola
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", 98165 Messina, Italy
| | - Fabio Mancino
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
| | - Lukas A Holzer
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Fremantle Hospitals Group, Perth, WA 6150, Australia
| | - Federico De Meo
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", 98165 Messina, Italy
| | - Ivan De Martino
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
- Adult Reconstruction and Joint Replacement Unit, Division of Sports Traumatology and Joint Replacement, Department of Ageing, Orthopaedic and Rheumatologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Salvatore Risitano
- A.O.U. Città della Salute e della Scienza, Centro Traumatologico Ortopedico (C.T.O.), Universitá di Torino, 10024 Turin, Italy
| | - Luigi Sabatini
- A.O.U. Città della Salute e della Scienza, Centro Traumatologico Ortopedico (C.T.O.), Universitá di Torino, 10024 Turin, Italy
| | - Pietro Cavaliere
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", 98165 Messina, Italy
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Li Z, Xu C, Chen J. Articulating spacers: what are available and how to utilize them? ARTHROPLASTY 2023; 5:22. [PMID: 37032343 PMCID: PMC10084623 DOI: 10.1186/s42836-023-00167-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/16/2023] [Indexed: 04/11/2023] Open
Abstract
Periprosthetic joint infection (PJI) is the most devastating complication following total joint arthroplasty (TJA) and is posing a global healthcare challenge as the demand for TJA mounts. Two-stage exchange arthroplasty with the placement of antibiotic-loaded spacers has been shown to be efficacious against chronic PJI. This study aimed to review the key concepts, types, and outcome evaluations of articulating spacers in the two-stage exchange for PJI. Previous studies indicated that articulating spacers have been widely used due to better functional improvement and a comparable infection control rate relative to static spacers. Several types of articulating spacers are reportedly available, including hand-made spacers, spacers fashioned from molds, commercially preformed spacers, spacers with additional metal or polyethylene elements, new or autoclaved prosthesis, custom-made articulating spacers, and 3D printing-assisted spacers. However, limited evidence suggested no significant difference in clinical outcomes among the different subtypes of articulating spacers. Surgeons should be familiar with different treatment strategies when using various spacers to know which is the most appropriate.
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Affiliation(s)
- Zhuo Li
- School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Chi Xu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jiying Chen
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
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Xiao Q, Ling T, Zhou K, Yuan M, Xu B, Zhou Z. Constrained acetabular liners are a viable option in second-stage re-implantation for chronic infected total hip arthroplasty with abductor or greater trochanter deficiency and large acetabular bone defects. BMC Musculoskelet Disord 2022; 23:915. [PMID: 36242038 PMCID: PMC9563789 DOI: 10.1186/s12891-022-05861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Abductor mechanism deficiency is a clear indication for using constrained acetabular liners (CALs), and large acetabular bone defects are considered a relative contraindication to CALs. We report the results of using CALs in special cases in which abductor or greater trochanter deficiency was accompanied by large acetabular bone defects at second-stage re-implantation for chronic infected total hip arthroplasty (THA). Methods Between January 2010 and January 2018, 19 patients who used CALs at second-stage re-implantation and had abductor or greater trochanter deficiency and large acetabular bone defects were included in this study. We followed up with the clinical and radiological results of these patients. Complications and infection-related information were also recorded. Results Eight patients, 4 patients, and 7 patients had Paprosky type IIB, type IIC, and type IIIA acetabular bone defects at second-stage re-implantation, respectively. The indication for using CALs was abductor deficiency in 14 patients and greater trochanter deficiency in the other 5 patients. The mean follow-up was 74.4 months (range 50–96). The mean Harris Hip Score (HHS) was 76.3 points (range 62–86) at the last follow-up. Three patients presented acetabular radiolucent lines with no progress: zone 3, zone 3 and zone 2 and 3, respectively. One patient suffered transient sciatic nerve palsy. There was no dislocation, failure of the CALs, reoperation, or recurrence of infection. Conclusion Our results suggested that for screened patients, CALs are a viable option in second-stage re-implantation for chronic infected THA with abductor or greater trochanter deficiency and large bone defects.
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Affiliation(s)
- Qiang Xiao
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China.,Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, People's Republic of China
| | - Tingxian Ling
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Kai Zhou
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Mingcheng Yuan
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Bing Xu
- Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China.
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