항생제 혼합 시멘트 충전물(Antibiotics-Loaded cement spacer)을 이용한 감염된 인공 고관절 치환술의 치료 = Treatment of Infected Hip Arthroplasty with Antibiotic-Loaded Cement Spacers

다국어 초록 (Multilingual Abstract)

Purpose: This study evaluated the effect of antibiotic-loaded cement spacers on the treatment of infected hip arthroplasty. Materials and Methods: Twenty-one patients, twenty-one cases that experienced infection after total hip arthroplasty, were treated with two-stage arthroplasty using antibiotic-loaded cement spacers between July 1995 and March 2005. The average age was 56.3 years (range, 36~84 years). The follow-up period was 7.2 years (range, 3~11.4 years). The period from the first operation to diagnosis of infection was 28 months (range, 1~49 months). Preoperative culture, Tc 99m scan or Gallium scan, intraoperative culture and biopsy were performed for the evaluation of infection. We postoperatively evaluated clinical and radiological outcomes, blood analysis including serologic study, complete blood cell count, differential count, erythrocyte sedimentation rate and C-reactive protein. Results: Of a total of 21cases, acetabular cup, femoral head and femoral stem were substituted in 10 cases (48%). Acetabular cup and femoral head were substituted in 11 cases (52%). Revision arthroplasty was performed in 19 cases, on average 11.9 months (range 2~31 months) after insertion of antibiotic-loaded cement spacers. Infection recurred in 1 case. In 18 cases, excluding the reinfected one, the average Harris hip score, 46.8 points (range, 35~72 points) preoperatively, improved to 89.5 points (range, 78~100 points) at last follow-up in the revision group. In 2 cases in which revision total hip arthroplasty was not performed, the Harris hip score was 53 points (range, 36~70 points) preoperatively, and 86 points (range, 72~100 points) at last follow-up. Conclusion: The use of antibiotic-loaded cement spacers in two-stage arthroplasty is an effective method for management of infection, preserving joint function until performing revision arthroplasty. Preservation of the femoral stem should be considered in cases in which were fixed firmly and in cases which show no evidence of the spreading of infection to the distal part of the stem on Tc 99m scan or Gallium scan performed preoperatively.

참고문헌 (Reference)

1 Hsieh PH, "Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis" 86 : 1989-1997, 2004

2 Volin SJ, "Two-stage reimplantation of total joint infections: a comparison of resistant and non-resistant organisms" 427 : 94-100, 2004

3 Balderston RA, "Treatment of the septic hip with total hip arthroplasty" 221 : 231-237, 1987

4 Lieberman JR, "Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol" 301 : 205-212, 1994

5 Younger AS, "Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis" 80 : 60-69, 1998

6 Yoon TR, "Treatment of infected uncemented total hip arthroplasty; two-stage revision procedure by preserving well-fixed femoral components in four cases" 35 : 467-471, 2000

7 Booth RE, "The results of spacer block technique in revision of infected total knee arthroplasty" 248 : 57-60, 1989

8 Phillips JE, "The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey" 88 : 943-948, 2006

9 Kendall RW, "Temporary antibiotic loaded acrylic hip replacement: a novel method for management of the infected THA" 5 : 171-177, 1994

10 Ivarsson I, "Revision of infected hip replacement. Two-stage procedure with a temporary gentamicin spacer" 65 : 7-8, 1994

11 Salvati EA, "Reimplantation in infection: a 12-year experience" 170 : 62-75, 1982

12 Wymenga AB, "Perioperative factors associated with septic arthritis after arthroplasty. Prospective multicenter study of 362 knee and 2,651 hip operations" 63 : 665-671, 1992

13 Antii-Poikia I, "Outcome of the infected hip arthroplasty" 60 : 670-675, 1989

14 Callaghan JJ, "One-stage revision surgery of the infected hip. A minimum 10-year follow up study" 369 : 139-143, 1999

15 Sanchez-Sotelo J, "Midterm to long-term followup of staged reimplantation for infected hip arthroplsty" 467 : 219-224, 2009

16 Buchholz HW, "Management of deep infection of total hip replacement" 63 : 342-353, 1981

17 Cordero J, "Influence of bacterial strains on bone infection" 14 : 663-667, 1996

18 Garvin KL, "Infection after total hip arthroplasty. Past, present, and future" 77 : 1576-1588, 1995

19 Bittar ES, "Girdlestone arthroplasty for infected total hip arthroplasty" 170 : 83-87, 1982

20 Hanssen AD, "Evaluation and treatment of infection at the site of a total hip or knee arthroplasty" 48 : 111-122, 1999

21 Ure KJ, "Direct-exchange arthroplasty for the treatment of infection after total hip replacement. An average ten-year followup" 80 : 961-968, 1998

22 Gristina AG, "Bacterial adherence to biomaterials and tissue" 67 : 264-273, 1985

23 Cui Q, "Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty" 89 : 871-882, 2007

24 Lord GA, "An uncemented total hip replacement: experimental study and review of 300 madreporique arthroplasties" 141 : 2-16, 1979

25 Deshmukh RG, "An intramedullary cement spacer in total hip arthroplasty" 13 : 197-199, 1998