Clinical and Radiographic Outcomes of a Long Cementless Monobloc Stem for Revision Total Hip Arthroplasty Due to Chronic Periprosthetic Infection.

IF 3.4 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty Pub Date : 2024-11-09 DOI:10.1016/j.arth.2024.11.007

Xing Liu, Yuhang Gao, Yi Leng, Jiarui Zhou, Xin Qi

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引用次数: 0

Abstract

Background: A long cementless monobloc stem is widely used for aseptic loosening, with satisfactory 5- to-10-year outcomes reported. Nonetheless, related studies on chronic periprosthetic joint infection (PJI) are scant. This study evaluated the clinical and radiographic outcomes of the stem in 2-stage revisions due to PJI.

Methods: This prospective multicenter cohort study consisted of patients from three medical centers who were enrolled in a single arm from January 2017 to May 2022. All patients were diagnosed with chronic PJI based on the International Consensus Meeting criteria and underwent 2-stage revisions using a long monobloc cementless revision stem. Among 44 patients, 37 (12 women and 25 men) completed an average follow-up of 35.6 months (range, 14 to 75). The primary outcome was the stability of the stem; secondary outcomes included infection eradication, Harris Hip Score, leg length discrepancy, major complications, and isolated pathogens at intraoperative cultures.

Results: At 1 year after revision, the infection-free prosthesis survival rate was 97.3% (95% confidence interval: 96.4 to 98.2). At the last follow-up, the mean subsidence was 2.9 ± 2.1 mm (range, 0.8 to 4.8). Postoperative leg length discrepancy averaged -4.6 ± 4.9 mm (range, -16 to 0). The Engh score averaged 14.1 ± 6.9 (range, zero to 22). The Harris Hip Score improved from a preoperative average of 35.7 ± 8.5 (range, 12 to 50) to 80.4 ± 9.3 (range, 58 to 92) at the 1-year postoperative follow-up (P < 0.01).

Conclusions: The long cementless monobloc stem used in the current study presents a feasible option for 2-stage revision in cases of chronic PJI. The bone ingrowth and stability could be observed within the short follow-up time.

Level of evidence: Level IV, prospective cohort study.

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慢性假体周围感染导致的全髋关节置换术翻修用长无骨水泥单体柄的临床和影像学结果

背景：长的无骨水泥单体骨干被广泛用于治疗无菌性松动，有报道称五到十年的治疗效果令人满意。然而，关于慢性假体周围关节感染（PJI）的相关研究却很少。本研究评估了因PJI而进行两阶段翻修的假体柄的临床和放射学结果：这项前瞻性多中心队列研究由来自三个医疗中心的患者组成，他们在2017年1月至2022年5月期间参加了单臂研究。所有患者均根据国际共识会议（ICM）标准被诊断为慢性PJI，并使用长单体无骨水泥翻修柄进行了两阶段翻修。在44名患者中，37人（12名女性和25名男性）完成了平均35.6个月（14至75个月）的随访。主要结果是骨柄的稳定性；次要结果包括感染根除、Harris髋关节评分、腿长差异、主要并发症和术中培养的分离病原体：翻修后一年，无感染假体存活率为97.3%（95% CI[置信区间]：96.4%至98.2%）。最后一次随访时，平均下沉量为 2.9 ± 2.1 毫米（范围为 0.8 至 4.8）。术后腿长差异平均为 -4.6 ± 4.9 毫米（范围为 -16 至 0）。Engh 评分平均为 14.1 ± 6.9（范围在 0 到 22 之间）。术后1年随访时，Harris髋关节评分从术前的平均35.7 ± 8.5（范围为12至50）提高到80.4 ± 9.3（范围为58至92）（P < 0.01）：本研究中使用的长型无骨水泥单体骨干是慢性PJI病例进行两阶段翻修的可行方案。在较短的随访时间内就能观察到骨的生长和稳定性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Arthroplasty 医学-整形外科

CiteScore

7.00

自引率

20.00%

发文量

734

审稿时长

48 days

期刊介绍： The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.