RESUMO
Antibiotic-impregnated hip cement spacers of various types and materials have been used in the treatment of periprosthetic hip infections. We developed a handmade spacer by using polymethylmethacrylate (PMMA) and/or α -tricalcium phosphate ( α -TCP). In this study, we retrospectively reviewed the surgical outcomes in 36 consecutive patients treated with 2-stage revision total hip arthroplasty by using our antibiotic-impregnated hip cement spacers. We aimed to analyze the infection control and reinfection rates after revision surgery. Moreover, we analyzed the possible predictors of postoperative reinfection. After exclusion of 1 patient who died immediately after the first-stage surgery, infection was controlled in 33 of the 36 hips (success rate, 91.7%). Two of these 33 hips underwent resection arthroplasty. Of the 36 hips that had been treated with the antibiotic-cement spacer, 31 hips (86.1%) were eligible for the second-stage prosthesis re-implantation. The 31 protocol hip joints of patients followed up for >6 months (mean, 48.6 months). Ten of these 31 hips (32.3%) became reinfected. No possible predictor examined differed significantly between the reinfection-positive and reinfection-negative groups. However, spacers consisting of PMMA cement alone were associated with the highest risk of reinfection. Therefore, α -TCP-containing antibiotic-impregnated hip cement spacers might decrease the reinfection rate in patients undergoing re-implantation.
Assuntos
Antibacterianos/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Cimentos Ósseos , Fosfatos de Cálcio/química , Feminino , Articulação do Quadril/cirurgia , Humanos , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Polimetil Metacrilato/química , Complicações Pós-Operatórias , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
We report the clinical and radiographic outcomes and complications of revision surgery using a cementless interlocking stem with an allograft-prosthesis composite (APC). This study included 11 patients with an average follow-up of 73 years. Of the 11 revisions, 1 was aseptic, 7 were septic, and 3 were periprosthetic femoral fractures. The mean Harris hip score improved from 25.6 points before surgery to 74.8 points at final follow-up. Osseous union at the proximal allograft-host bone junction occurred in 10 hips (90.9%) ; the greater trochanter did not unite in 4 of 7 hips (57.1%). Moderate and severe allograft resorption occurred in one hip each. Postoperative complications included 1 deep infection, 2 heterotopic ossifications, and 1 dislocation. Using an interlocking stem with an allograft-prosthesis composite in revision surgery provided acceptable results in the presence of circumferential massive bone deficiency of the proximal femur.
Assuntos
Artroplastia de Quadril/métodos , Prótese de Quadril , Desenho de Prótese , Adulto , Idoso , Cimentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Reoperação , Transplante HomólogoRESUMO
BACKGROUND: Previous studies comparing antibiotic-loaded calcium phosphate cement to polymethylmethacrylate cement reported that although the former has higher elution volumes over a longer period, it is mechanically weak when used alone. To counter this problem, a double-layered antibiotic-loaded cement spacer in which calcium phosphate cement is coated with polymethylmethacrylate cement was created. METHODS: In this study, we compared the double-layered spacer to the polymethylmethacrylate cement spacer in terms of eluent antibiotic concentration, bioactivity against methicillin-resistant Staphylococcus aureus, and mechanical strength. Double-layered and polymethylmethacrylate cement spacers that were loaded with vancomycin (VCM) were prepared and immersed in phosphate buffer for 84 days. To facilitate VCM elution from calcium phosphate cores in double-layered spacers, we also drilled multiple holes into the calcium phosphate layer from the spacer surface. RESULTS: We found that VCM concentrations in double-layered spacer eluents were higher than those in polymethylmethacrylate cement spacer eluents. The double-layered spacer also had higher bioactivity than the polymethylmethacrylate cement spacer. Although the polymethylmethacrylate cement spacer eluent lost the ability to inhibit bacterial growth on day 56, the double-layered spacer eluent maintained this ability for the duration of our study. Finally, the double-layered spacer retained high mechanical strength throughout the study period. CONCLUSIONS: The beneficial biomechanical and drug-eluting properties of the double-layered spacer might qualify it to serve as a promising biomaterial that could be used for managing periprosthetic joint infections.
Assuntos
Antibacterianos/administração & dosagem , Cimentos Ósseos/química , Sistemas de Liberação de Medicamentos/instrumentação , Infecções Relacionadas à Prótese/tratamento farmacológico , Vancomicina/administração & dosagem , Antibacterianos/farmacologia , Materiais Biocompatíveis/química , Fosfatos de Cálcio , Sistemas de Liberação de Medicamentos/métodos , Humanos , Técnicas In Vitro/métodos , Teste de Materiais/métodos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento , Polimetil Metacrilato , Vancomicina/farmacologiaAssuntos
Artroplastia de Quadril/métodos , Cimentos Ósseos , Prótese de Quadril , Idoso , Feminino , Humanos , Desenho de Prótese , ReoperaçãoRESUMO
BACKGROUND CONTEXT: Surgical site infection (SSI) is a serious postoperative complication. The incidence of SSIs is lower in clean orthopedic surgery than in other fields, but it is higher after spinal surgery, reaching 4.15% in high-risk patients. Several studies reported that triclosan-coated polyglactin 910 sutures (Vicryl Plus; Ethicon, Inc., Somerville, NJ, USA) significantly reduced the infection rate in the general surgical, neurosurgical, and thoracic surgical fields. However, there have been no studies on the effects of such coated sutures on the incidence of SSIs in orthopedics. PURPOSE: To compare the incidence of wound infections after spinal surgery using triclosan-coated suture materials with that of noncoated ones. STUDY DESIGN/SETTING: A retrospective, nonrandomized, and clinical study. PATIENT SAMPLE: From May 2010 to April 2012, 405 patients underwent a spinal surgical procedure in the Department of Orthopedic Surgery of two university hospitals. OUTCOME MEASURES: The primary outcome was the number of wound infections and dehiscences. METHODS: Two hundred five patients had a conventional wound closure with polyglactin 910 suture (Vicryl) between May 2010 and April 2011 (Time Period 1 [TP1]), and 200 patients underwent wound closure with triclosan-coated polyglactin 910 suture (Vicryl Plus) between May 2011 and April 2012 (TP2). Statistical comparisons of wound infections, dehiscence, and risk factors for poor wound healing or infection were performed. None of the authors has any conflict of interest associated with this study. RESULTS: There were two cases of wound dehiscence in TP1 and one in TP2 (p=.509). Using noncoated sutures in TP1, eight patients (3.90%) had wound infections, whereas one patient (0.50%) had wound infections in TP2 (using triclosan-coated sutures); the difference was significant (p=.020). CONCLUSIONS: The use of triclosan-coated polyglactin 910 sutures instead of polyglactin 910 sutures may reduce the number of wound infections after spinal surgery.
Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Traumatismos da Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Suturas/efeitos adversos , Triclosan/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Poliglactina 910/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Infecção dos Ferimentos/prevenção & controleRESUMO
BACKGROUND CONTEXT: Although severe cervical kyphotic deformity results from a number of causes, the psychiatric disease itself did not play a metabolic role in the development of the deformity. However, we diagnosed a case of cervical deformity caused by postural disorders associated with schizophrenia. PURPOSE: The purpose of this case report is to describe a rare episode in a schizophrenic patient with a fixed cervical flexion deformity caused by postural disorders. STUDY DESIGN: A case report. PATIENT SAMPLE: An 18-year-old woman with a history of schizophrenia and a persistent behavioral cervical flexion posture presented for evaluation. At the initial examination, a significant fixed cervical flexion measuring 100° was noted. Her chin was in contact with her manubrium, and left scars developed on both her chin and manubrium. She had hyperreflexia in all extremities but no further neurologic deficits, although her initial magnetic resonance imaging (MRI) indicated multilevel cervical cord compression. METHODS: She was initially treated conservatively but had a progression in fixed cervical flexion positioning. She complained of a persistent inability to ambulate within the community, as she was unable to bring her head into a neutral position to be able to see objects in her path. She also complained of inability to drink from a water bottle as she had difficulty depressing her mandible. The patient and her family requested a surgical correction. Although she had no significant clinical neurologic deficit, she did have significant MRI findings and limitation of functional activities. We felt her limitations were significant enough to warrant surgical correction. RESULTS: A combined anterior and posterior procedure was performed resulting in an improved cervical head posture. She was able to return to community activities and resume drinking from a water bottle. CONCLUSIONS: Although this technique has been well described previously, this is the first report of a rare episode in a schizophrenic patient with severe cervical kyphosis deformity because of a constant neck flexion posture.
Assuntos
Vértebras Cervicais/cirurgia , Cifose/etiologia , Postura/fisiologia , Esquizofrenia/complicações , Adolescente , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Cifose/fisiopatologia , Cifose/cirurgia , Amplitude de Movimento Articular/fisiologia , Esquizofrenia/fisiopatologia , Esquizofrenia/cirurgiaRESUMO
Adequate fixation at the time of cementless stem implantation depends on the operator's experience. An objective evaluation method to determine whether the stem has been appropriately implanted may be helpful. We studied the relationship between the hammering sound frequency during stem implantation and internal stress in a femoral model, and evaluated the possible usefulness of hammering sound frequency analysis for preventing intraoperative fracture. Three types of cementless stem (BiCONTACT®, SL-PLUS®, and AI-Hip®) were used. Surgeons performed stem insertion using a procedure similar to that employed in a routine operation. Stress was estimated by finite element analysis, the hammering force was measured, and frequency analysis of hammering sound data obtained using a microphone. Finite element analysis showed a decrease in the hammering sound frequency with an increase in the estimated maximum stress. When a decrease in frequency was observed, adequate hammering had occurred, and the continuation of hammering risked fracture. Based on the relationship between stress and frequency, the evaluation of changes in frequency may be useful for preventing the development of intraoperative fractures. Using our method, when a decrease in frequency is observed, the hammering force should be reduced. Hammering sound frequency analysis may allow the prediction of bone fractures that can be visually confirmed, and may be a useful objective evaluation method for the prevention of intraoperative periprosthetic fractures during stem insertion.
Assuntos
Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur/etiologia , Prótese de Quadril , Fraturas Periprotéticas/prevenção & controle , Falha de Prótese , Espectrografia do Som/métodos , Artroplastia de Quadril/instrumentação , Cimentação , Fraturas do Fêmur/diagnóstico , Humanos , Complicações Intraoperatórias , Período Intraoperatório , Modelos Anatômicos , Fraturas Periprotéticas/diagnóstico , Desenho de Prótese , Som , Estresse MecânicoRESUMO
Infected hip prosthesis, a serious complication of primary total hip arthroplasty (THA), can have severe consequences. We report the treatment outcome of two-stage revision THA for infected hip arthroplasty, including hemiarthroplasty, using an antibiotic-impregnated cement spacer for the interval between the first and second stages. Between 1996 and 2000 we performed this procedure on nine hips in eight patients. Cementless revision THA was performed as the second-stage procedure. Bone defects were restored with frozen allografts. The outcome was evaluated using the hip score of the Japanese Orthopaedic Association (JOA hip score). The mean duration of follow-up was 35.7 months (range 10-55 months). The mean JOA hip score at follow-up improved from 30.1 (range 10-74) to 73.2 (24-96). The mean interval between the first and second stages was 10.1 weeks (range 6-19 weeks). Eight of the nine hips achieved a successful outcome. One hip, with methicillin-resistant Staphylococcus aureus infection, experienced recurrence 4 months after revision THA. This patient was successfully treated 14 months after the first revision THA with a second two-stage procedure using a vancomycin- and arbekacin-impregnated cement spacer and beads. These results suggest that two-stage revision THA using an antibiotic-impregnated cement spacer is a useful technique for treating infected hip arthroplasty.