The revision of the two phase treatment represents a golden standard in the treatment of infected endoprosthesis. Throughout this study, the results of 21 patients with an infected hip endoprosthesis treated in two phases have been processed, with the use of an antibiotic spacer, within the period of 2009 and 2012. Thereby, a unique protocol for diagnosis and treatment of infections has been applied to all the patients, which entails a preoperational x-ray image, laboratory findings (Se, CRP), as well as a puncture aspiration with a microbiological and biochemical examination of the aspirated fragments. The operational treatment consists of: taking a sample for microbiological and histopathological diagnosis, removal of the implanted endoprosthesis, excision of the avascular and necrotic tissue and installing an antibiotic spacer. Postoperatively, the patients are treated with a parenteral application of an antibiotics based on an antibiogram, throughout a period of two weeks, and later on an oral treatment, a combination of two antibiotics, depending on the antibiogram, within the following four to six weeks. After the appeasement of the local findings and the laboratory results, a revision with a removal of the antibiotic spacer and reimplantation of an endoprosthesis - revisional or primary has been conducted on the patients, depending on the bone deficit. The functionality of the joint is graded based on the Haris Hip Score. The patients are being observed postoperatively for a period of 12 to 36 months. A definite reimplantation has been applied to 20 patients, while one patient has been treated with a resection method. The Haris Hip Score was 45 preoperatively, and 80 postoperatively. The applied protocol of the treatment of infected endoprosthesis is effective in the eradication of the infection and the final reimplantation.
Porous metal augments have been used successfully for management of large acetabular defects during revision hip arthroplasty. This study analyzes and compares the clinical and radiographic outcomes of porous metal augments in cemented and uncemented acetabular revisions, all performed at the same institution. In the period 2015-2017, 36 patients with 37 large acetabular defects were treated with porous metal augments in cemented and uncemented acetabular revisions. Postoperatively, patients were monitored for two years on average period of 24-36 months. Acetabular augments were used when preoperative and intraoperative findings indicated the presence of large acetabular defects that can hinder the stability of the revision implants. We used lateral approach, 36 mm femoral head, and cementless or cemented acetabular cup depending on local bone quality. Postoperatively, all patients followed total hip arthroplasty precautions, with weight bearing as tolerated regimen with use of crutches during 6 weeks after surgery. The follow-up was radiological and clinical. We used HHS. At a mean follow-up of two years (range 24-36 months) one patient had reinfection and one patient had infection. None of the patients shown signs of aseptic augment or acetabular cup loosening. Porous metal augments show comparable excellent radiographic and clinical short-term outcomes, when combined with cemented or uncemented cups in revision hip arthroplasty. They allow good bone ingrowth, adequate implant contact and good stability. Complications were related to infection and not related to the augments itself.
1 JZU GOB "8 Septemvri" Skopje, Oddelenie za ortopedija i traumatologija, 2 JZU Univerzitetska klinika za revmatologija Skopje, Univerzitet "Sv. Kiril i Metodij", Medicinski fakultet Skopje, Republika Makedonija Apstrakt Voved. Tretmanot vo dve fazi na inficirani endoprotezi pretstavuva zlaten standard vo mnogu ustanovi vo svetot. Vo periodot 2008-2012 god. se tretirani 21 pacient so infekcija na implantirani endoprotezi na koleno. Metodi. Kaj site od niv be{e primenet edinstven protokol na dijagnoza i tretman na infekciite, koj{to opfa}a{e predoperativna RTG-slika, laboratoriski serolo{ki isleduvawa (sedimentacija-Ce rekativen protein) i aspiraciona punkcija so mikrobiolo{ko i biohemisko isleduvawe na punktatot. Operativniot tretman se sostoe{e vo: zemawe primerok za mikrobiolo{-ka i patohistolo{ka dijagnoza, vadewe na implantiranata proteza, ekscizija na avaskularnoto i nekroti~no tkivo, postavuvawe antibiotski cementen spejser. Postoperativno, pacientite bea tretirani so intravenozna aplikacija na antibiotik po antibiogram vo traewe od dve nedeli, a potoa so peroralen tretman vo kombinacija na dva antibiotika (ciprofloksacin i rifampicin), odnosno po antibiogram vo narednite ~etiri do {est nedeli. Po smiruvaweto na lokalniot naod i laboratoriskite rezultati kaj pacientite, be{e izvedena revizija so vadewe na antibiotskiot spejser i reimplantacija na endoproteza, primarna ili reviziona, vo zavisnost od koskeniot deficit. Rezultati. Kaj eden pacient postapkata be{e povtorena vo tri navrati, eden pacient zavr{i so artrodeza, a ostanatite devetnaeset so reimplantacija. Postoperativno, pacientite se sledat 36 meseci. Kaj eden pacient so reimplantacija se pojavi reinfekcija po 6 meseci od vtorata faza na operativnoto lekuvawe. Funkcionalnite isledu-____________ Korespondencija i reprint do: Jasmin Ciriviri, JZU GOB "8 Septemvri" Skopje, Oddelenie za ortopedija i traumatologija, "Pariska" b.b. 1000 Skopje, R. Makedonija; Tel.: 070 323 537; E-mail: jasminc@unet.com.mk vawa se spored КСС (Knee society score), predoperativno 36,66 i postoperativno po edna godina od reintervencijata 77,84. Procentot na uspeh vo lekuvaweto so ovaa metoda iznesuva 85,71. Zaklu~ok. Tretmanot vo dve fazi ovozmo`uva zadovolitelen uspeh vo tretmanot na inficiranite endoprotezi. Artikulira~kiot antibiotski cementen spejser e superioren vo smiruvaweto na lokalniot naod. Ovozmo`uva delumna funkcija na zglobot i ja olesnuva vtorata intervencija. Infekciite predizvikani so stafilokokus aureus se te{ki za tretman i so pogolem procent recidivi.Klu~ni zborovi: infekcija, koleno, endoproteza, revizija, spejser. ___________________________________________ Abstract Introduction. Two-stage revision surgery for infected knee endoprosthesis using antibiotic articulating spacer is the best possible standard in most of the orthopedic centers worldwide. Methods. In the period from 2008 to 2012 we treated 21 patients with infected knee endoprosthesis. We used a single protocol for diagnosis and treatment of infection which included x-ray examination, serologic...
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