Handmade spacers for two-stage exchange at the hip.

IF 1 4区医学 Q3 ORTHOPEDICS

Operative Orthopadie Und Traumatologie Pub Date : 2023-06-01 DOI:10.1007/s00064-023-00811-z

Sebastian von Hertzberg-Bölch, Martin Luedemann, Jan Oberfeld, Axel Jakuscheit, Maximilian Rudert

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引用次数: 0

Abstract

Objective: Two-stage exchange with implantation of a temporary spacer is the gold standard treatment for chronic periprosthetic joint infection of the hip. This article describes a simple and safe technique for handmade spacers at the hip.

Indication: Periprosthetic joint infection of the hip. Septic arthritis of the native joint.

Contraindications: Known allergy against components of polymethylmethacrylate bone cements. Inadequate compliance for two-stage exchange. Patient unfit to undergo two-stage exchange. Bony defect situation at the acetabulum impeding stable reduction of the spacer. Bone loss at the femur jeopardizing stable fixation of the stem. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy.

Surgical technique: Tailoring bone cement with antibiotics. Preparation of a metal endoskeleton. Molding of spacer stem and head by hand. Customizing spacer off-sets to bony anatomy and soft tissue tension. Implantation assuring rotational stability at the femur with a bone cement collar. Confirmation of correct position by intraoperative radiography.

Postoperative management: Restricted weight-bearing. Range of motion as possible. Reimplantation after successful treatment of infection.

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手工垫片两阶段交换在臀部。

目的:两期置换术联合临时垫片植入是治疗髋关节慢性假体周围关节感染的金标准。这篇文章介绍了一个简单和安全的技术手工垫片在臀部。适应症:髋关节假体周围感染。原生关节的脓毒性关节炎。禁忌症:已知对聚甲基丙烯酸甲酯骨水泥成分过敏。两阶段交换的合规性不足。病人不适合进行两阶段交换。髋臼骨缺损情况妨碍间隔器稳定复位。股骨处骨质流失，危及骨干的稳定固定。软组织损伤需要塑料临时真空辅助伤口闭合(VAC)治疗。手术技术:用抗生素剪裁骨水泥。金属内骨骼的制备。隔震杆和隔震头手工成型。根据骨骼解剖和软组织张力定制垫片偏移。通过骨水泥环植入确保股骨旋转稳定。术中x线片确认正确体位。术后处理:限制负重。尽可能的活动范围。感染治疗成功后再植。

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

Operative Orthopadie Und Traumatologie ORTHOPEDICS-

CiteScore

2.10

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Orthopedics and Traumatology is directed toward all orthopedic surgeons, trauma-tologists, hand surgeons, specialists in sports injuries, orthopedics and rheumatology as well as gene-al surgeons who require access to reliable information on current operative methods to ensure the quality of patient advice, preoperative planning, and postoperative care. The journal presents established and new operative procedures in uniformly structured and extensively illustrated contributions. All aspects are presented step-by-step from indications, contraindications, patient education, and preparation of the operation right through to postoperative care. The advantages and disadvantages, possible complications, deficiencies and risks of the methods as well as significant results with their evaluation criteria are discussed. To allow the reader to assess the outcome, results are detailed and based on internationally recognized scoring systems. Orthopedics and Traumatology facilitates effective advancement and further education for all those active in both special and conservative fields of orthopedics, traumatology, and general surgery, offers sup-port for therapeutic decision-making, and provides – more than 30 years after its first publication – constantly expanding and up-to-date teaching on operative techniques.