RESUMEN
Aims: To explore the clinical efficacy of using two different types of articulating spacers in two-stage revision for chronic knee periprosthetic joint infection (kPJI). Methods: A retrospective cohort study of 50 chronic kPJI patients treated with two types of articulating spacers between January 2014 and March 2022 was conducted. The clinical outcomes and functional status of the different articulating spacers were compared. Overall, 17 patients were treated with prosthetic spacers (prosthetic group (PG)), and 33 patients were treated with cement spacers (cement group (CG)). The CG had a longer mean follow-up period (46.67 months (SD 26.61)) than the PG (24.82 months (SD 16.46); p = 0.001). Results: Infection was eradicated in 45 patients overall (90%). The PG had a better knee range of motion (ROM) and Knee Society Score (KSS) after the first-stage revision (p = 0.004; p = 0.002), while both groups had similar ROMs and KSSs at the last follow-up (p = 0.136; p = 0.895). The KSS in the CG was significantly better at the last follow-up (p = 0.013), while a larger percentage (10 in 17, 58.82%) of patients in the PG chose to retain the spacer (p = 0.008). Conclusion: Prosthetic spacers and cement spacers are both effective at treating chronic kPJI because they encourage infection control, and the former improved knee function status between stages. For some patients, prosthetic spacers may not require reimplantation.
RESUMEN
Bone implants for different body parts require varying mechanical properties, dimensions, and biodegradability rates. Currently, it is still challenging to produce artificial bones with perfect compatibility with human bones. In this study, a silk-fabric reinforced silk material (SFS) composed of pure silk with exceptional biocompatibility, osteogenesis, and biodegradability is reported, and demonstrates its outstanding performance as a bone implant material. The SFS is fabricated using a simple hot-pressing technique, with degummed silk fabric as the reinforcement and silk fibroin as the matrix. The SFS as a self-reinforced composite, has exceptional mechanical properties due to the almost perfect interface between the matrix and reinforcement. More importantly, its mechanical properties, biodegradability rates, and density can be tailored by adjusting the reinforcement structure and the ratio of the reinforcement to the matrix to align with the requirements for bone implantation in different parts of the human body. Besides, the SFS can improve osteoblastic proliferation and increase osteogenic activity, which is not the case with clinically used titanium alloy artificial bone. Therefore, the SFS holds significant potential to replace conventional metal or ceramic implants in the field of medical fracture repair.