Biomedical subjects

Chun-Hsiung Shih

Publications and source records attributed to Chun-Hsiung Shih.

At least 19 recordsLinked to original sources

PubMed2006

The effect of necrotic lesion size and rotational degree on the stress reduction in transtrochanteric rotational osteotomy for femoral head osteonecrosis--a three-dimensional finite-element simulation.

BACKGROUND: The prospect for success in the efficacy of osteotomy for precollapse stage of femoral head osteonecrosis depends on the ability to predict reliably the stress changes derived from specific osteotomies. A three-dimensional finite-element analysis was thus designed to compute necrotic femoral head stress changes with different extent of necrocrosis that accompany anterior or posterior rotational osteotomies. METHOD: Computed tomography images of a standard composite femur were used to create the three-dimensional finite-element intact femur model. Based on the intact model, 27 models simulating three different levels of necrotic region together with nine different rotational osteotomies were created. The von Mises stress distributions of each model were analyzed and compared for a loading condition simulating single-legged stance. FINDINGS: (1) The stress reduction in anterior rotational osteotomy is more effective as compared to that of the posterior rotational osteotomy for various necrotic lesion sizes. (2) Von Mises stress on the necrotic zone decreased with increasing rotational angle. The decreasing rate was higher for the femoral head with a narrow lesion. (3) Femoral head with a wider necrotic lesion had a higher risk for developing collapse due to high local stress on the surface of necrotic region; whereas the necrotic region tended to expand in size instead of collapse for femoral head with a narrow lesion due to high local stress on the interface between necrotic region and healthy bone. INTERPRETATION: Transtrochanteric rotational osteotomy is a technically demanding procedure and associated with high complication risks, a more scrupulous planning including the finite-element analysis should be considered before doing surgery in clinical subjects.

Femur Head↗

PubMed2006

Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon autograft: clinical outcome in 4-7 years.

Surgical reconstruction of the anterior cruciate ligament (ACL) is indicated in the ACL-deficient knee with symptomatic instability and multiple ligaments injuries. In the present study, we describe the clinical results of quadriceps tendon-patellar bone autograft for ACL reconstruction. From 1996 to 1998, the graft has been used in 38 patients. Thirty-four patients with complete final follow-up for 4-7 years were analyzed. The average follow-up time was 62 (48-84) months. Thirty-two patients (94%) achieved good or excellent results by Lysholm knee rating. Twenty-six patients (76%) could return to moderate or strenuous activity after reconstruction. Twenty-eight patients (82%) had ligament laxity of less than 2 mm. Finally; 31 patients (91%) were assessed as normal or nearly normal rating by IKDC guideline. Twenty-five patients (73%) had less than 10 mm difference in thigh girth between their reconstructed and normal limbs. Thirty-two (94%) and 31 (91%) patients could achieve recovery of the extensor and flexor muscle strength in the reconstructed knee to 80% or more of normal knee strength, respectively. A statistically significant difference exists in thigh girth difference, extensor strength ratio, and flexor strength ratio before and after reconstruction. Tunnel expansion with more than 1 mm was identified in 2 (6%) tibial tunnels. Our study revealed satisfactory clinical subjective and objective results at 4-7 years follow-up. Quadriceps tendon autograft has the advantage of being self-available, relatively easier arthroscopic technique, and having a suitable size, making it an acceptable graft choice for ACL reconstruction. There is little quadriceps muscle strength loss after quadriceps harvest. A quadriceps tendon-patellar autograft is an adequate graft choice to ACL reconstruction.

Adolescent↗

PubMed2006

Arthroscopic posterior cruciate ligament reconstruction with hamstring tendon autograft: results with a minimum 4-year follow-up.

This study prospectively evaluates the outcomes at a minimum 4-year follow-up after PCL reconstruction using quadruple hamstring tendon autograft with an arthroscopic double fixation technique. During 1996-1999, hamstring tendon autograft graft has been used in 57 patients. Data from 52 patients who had been followed up completely were analyzed. All patients suffered from a grade 3 or higher grade of posterior drawer test and posterior sag sign with MRI image confirmation. Twelve knees had combined posterior and posterolateral instability, which were simultaneously reconstructed. Clinical assessments included Lysholm knee score, International Knee Documentation Committee (IKDC) scores, KT-1000 instrumented test, thigh muscle assessment, and radiographic evaluation. The mean Lysholm score was 54 (40-65) and 91 (65-100) points (P<0.01) before and after surgery. Thirty (58%) patients could return to moderate or strenuous activity. The evaluation of AP translation has been performed with KT-1000. The average posterior displacement measured with KT-1000 was 11.69+/-2.01 mm preoperatively and 3.45+/-2.04 mm postoperatively. Forty-two (81%) patients demonstrated ligament laxity of less than 5 mm. Forty-two (81%) patients were rated as normal or nearly normal based on IKDC scores. Forty-six (88%) patients achieved a minimum of 80% recovery of extensor strength and 44 (85%) patients achieved a minimum of 80% recovery of flexor strength. Statistically significant differences existed in thigh girth, extensor strength, and flexor strength before and after reconstruction. Arthroscopic reconstruction for PCL with four-strand hamstring tendon graft produced satisfactory results. The semitendinosus and gracilis tendon graft is adequate in graft size, technically easier to perform and more reproducible, and had a satisfactory result.

Adult↗

PubMed2006

Staged arthroplasty as salvage procedure for deep hip infection following intertrochanteric fracture.

Deep hip infection is a rare complication of intertrochanteric fractures and an optimal treatment has not yet been reported. Twenty-seven patients who contracted deep hip sepsis following the failed primary treatment of an intertrochanteric fracture were treated with two-stage hip arthroplasty. Antibiotic-impregnated cement beads were implanted following resection arthroplasty in the first 15 patients, and a temporary cement spacer prosthesis was used in the other 12 hips. There was only one recurrence of infection at an average follow-up of 4.8 years. Complications included non-union of the greater trochanter in four patients, intraoperative femoral fracture in two and fracture of the cement prosthesis in one. The use of an interim spacer was associated with better hip function in the interim period; a decreased operative time and less blood loss at the time of arthroplasty; and a higher hip score at final follow-up. Staged arthroplasty is an effective salvage procedure for deep hip infection after the failed treatment of an intertrochanteric fracture. The use of a temporary spacer maintains hip function between stages, makes arthroplasty less complicated, and improves the clinical outcome.

Adult↗

PubMed2006

High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex cement spacers in two-stage revision of infected hip implants: a study of 46 patients at an average follow-up of 107 days.

This study investigated the release of antibiotics in vivo, from an articulating polymethylmethacrylate (PMMA) spacer used in two-stage revision arthroplasty of infected hip implants. Forty-six patients who underwent two-stage revision hip arthroplasty for infections were managed with an interim PMMA spacer loaded with a high dose of vancomycin and aztreonam. Serum and aliquots of drainage collected after the first-stage surgery, and joint fluid obtained at the time of the second-stage surgery were analyzed for antibiotic concentrations by high performance liquid chromatography and bioactivity by tube dilution bioassay. Following implantation, the highest levels of antibiotics were measured in aliquots of drainage on the first day (vancomycin: 1538.0 +/- 243.6 microg/mL; aztreonam: 1003.5 +/- 323.5 microg/mL), decreasing to 571.9 +/- 169.4 microg/mL for vancomycin and 313.6 +/- 88.3 microg/mL for aztreonam after 7 days. Antibiotic concentrations in serum were very low (vancomycin: 0.58 +/- 0.2 microg/mL, range: 0.1-1.6 microg/mL; aztreonam: 0.46 +/- 0.3 microg/mL, range: 0.1-0.9 microg/mL at 24 h) and there was no systemic adverse effect. At a mean 107 days after the first-stage surgery, the concentrations of antibiotics in joint fluid were well above the minimal inhibitory concentration of most common microorganisms. The released antibiotics were bioactive against the test organisms. Based on the observed results, we confirmed the safety and effectiveness of in vivo drug delivery from antibiotic-impregnated PMMA hip spacers.

Aged↗

PubMed2006

Precooling of the femoral canal enhances shear strength at the cement-prosthesis interface and reduces the polymerization temperature.

Preheating of the femoral stem in total hip arthroplasty improves the cement-prosthesis bond by decreasing the interfacial porosity. The main concern, however, is the potential thermal osteonecrosis because of an increased polymerization temperature. In this study, the effects of femoral canal precooling on the characteristics of the cement-stem interface were evaluated in an experimental model for three test conditions: precooling of the femoral canal, preheating of the stem (44 degrees C), and a control in which stems were inserted at room temperature without thermal manipulation of the implant, cement, or bone. Compared to the control group, precooling of the femoral canal and preheating of the stem had similar effects on the cement-stem interface, with greater interfacial shear strength and a reduced porosity. Femoral canal precooling also produced a lower temperature at the cement-bone interface. No difference was found in the ultimate compressive strength of bone cement for the three preparation conditions. Based on this laboratory model, precooling of the femoral canal could improve shear strength and porosity at the stem-cement interface, minimize thermal injury, and maintain the mechanical strength of the cement.

Arthroplasty, Replacement, Hip↗

PubMed2006

Image-guided periacetabular osteotomy: computer-assisted navigation compared with the conventional technique: a randomized study of 36 patients followed for 2 years.

BACKGROUND: Periacetabular osteotomy (PAO) is an effective but technically demanding surgical procedure. We evaluated the efficiency of computer-assisted navigation in PAO and compared it with the traditional approach. PATIENTS AND METHODS: We performed a randomized study of 36 patients undergoing PAO using either the CT-based, computer-assisted navigation technique or the conventional approach. The operative details, radiographic results, and functional outcomes were compared between groups. RESULTS: Patients in the conventional surgery group required an average of 4.4 (2-7) images of intraoperative radiographs, whereas only 0.6 (0-1) images were required in the navigation group. The operation time was 21 min shorter with computer-assisted navigation. No significant difference with regard to operative blood loss, transfusion requirement, correction of deformity, and functional improvement was found. Complications such as intraarticular damage, osteonecrosis, or neurovascular injury were not encountered. INTERPRETATION: A computer-assisted navigation system is a feasible tool to provide real-time image guidance and facilitate PAO. However, it offers little additional benefit when the surgery is done by an experienced surgeon.

Acetabulum↗

PubMed2005

Evaluating hip labral tears using magnetic resonance arthrography: a prospective study comparing hip arthroscopy and magnetic resonance arthrography diagnosis.

PURPOSE: To evaluate the sensitivity and accuracy of magnetic resonance arthrography (MRA) with true sagittal scout image mapped radial reformation in localizing hip labral tears. TYPE OF STUDY: Case series. METHODS: Thirty patients were examined with hip MRA because of suspected labral tears. Every patient underwent normal hip arthrography and MR examinations using a 1.5-T scanner with a 3D-FLASH pulse sequence. Multiplanar reformation using double oblique technique produced radial reformatted rotation images with 10 degrees increment on the acetabular rim. Labral tears were annotated as anterior-superior (AS), anterior-inferior (AI), posterior-superior (PS), and posterior-inferior (PI) quadrant based on the cranial-caudal axis in true sagittal reformatted scout localizing image. Patients with positive MRA findings were counseled to have the arthroscopic hip procedure. RESULTS: Five patients showed no MRA indication of labral tear. Of 25 patients who had MRA evidence of labral tear, 17 underwent arthroscopic hip surgery. One patient had only synovial process in the hip joint near the suspected MRA area. The remaining 16 operated patients had labral tears with a total of 21 quadrant lesions on arthroscopy (distributed as AS, 14; AI, 3; PS, 2; and PI, 2). Radial reformatted images revealed accurate mapping with arthroscopic findings in 21 of the 22 quadrant lesions. The sensitivity and accuracy of MRA for the diagnosis of hip labral tear were 100% and 94%, respectively, and the sensitivity and accuracy of radial reformatted MRA for mapping the tear location were 100% and 96%, respectively. CONCLUSIONS: MRA using radial reformatted images with a true sagittal localizer may achieve superior success rates in diagnosing hip labral lesions and in guiding the arthroscopist in portal selection, thus rendering location of hip labral tears simpler in surgery. It supplied detailed preoperative information to the surgeon, avoiding unnecessary surgery for patients if the diagnosis was unconfirmed. LEVEL OF EVIDENCE: Level III.

Acetabulum↗

PubMed2005

The degrees to which transtrochanteric rotational osteotomy moves the region of osteonecrotic femoral head out of the weight-bearing area as evaluated by computer simulation.

BACKGROUND: Transtrochanteric rotational osteotomy is a technical demanding procedure. Currently, the pre-operative planning of the transtrochanteric rotational osteotomy is mostly based on X-ray images. The surgeons would need to reconstruct the three-dimensional structure of the femoral head and the necrosis in their mind. This study develops a simulation platform using computer models based on the computed tomography images of the femoral head to evaluate the degree to which transtrochanteric rotational osteotomy moves the region of osteonecrotic femoral head out of the weight-bearing area in stance and gait cycle conditions. Based on this simulation procedure, the surgeons would be better informed before the surgery and the indication can be carefully assessed. METHOD: A case with osteonecrosis involving 15% of the femoral head was recruited. Virtual models with the same size lesion but at different locations were devised. Computer models were created using SolidWorks 2000 CAD software. The area ratio of weight-bearing zone occupied by the necrotic lesion on two conditions, stance and gait cycle, were measured after surgery simulations. FINDINGS: For the specific case and virtual models devised in this study, computer simulation showed the following two findings: (1) The degrees needed to move the necrosis out of the weight-bearing zone in stance were less by anterior rotational osteotomy as compared to that of posterior rotational osteotomy. However, the necrotic region would still overlap with the weight-bearing area during gait cycle. (2) Because the degrees allowed for posterior rotation were less restricted than anterior rotation, posterior rotational osteotomies were often more effective to move the necrotic region out of the weight-bearing area during gait cycle. INTERPRETATION: The computer simulation platform by registering actual CT images is a useful tool to assess the direction and degrees needed for transtrochanteric rotational osteotomy. Although the results indicated that anterior rotational osteotomy was more effective to move the necrosis out of the weight-bearing zone in stance for models devised in this study, in circumstances where the necrotic region located at various locale, considering the limitation of anterior rotation inherited with the risk of vascular compromise, it might be more beneficial to perform posterior rotation osteotomy in taking account of gait cycle.

Computer Simulation↗

PubMed2005

Periprosthetic fractures of the greater trochanter through osteolytic cysts with uncemented MicroStructured Omnifit prosthesis: retrospective analyses pf 23 fractures in 887 hips after 5-14 years.

BACKGROUND: Periprosthetic fractures of the greater trochanter through osteolytic cysts are rare. The proper treatment and its influence on the prosthetic survival remains unknown. PATIENTS AND METHODS: We retrospectively evaluated 887 hips with uncemented MicroStructured Omnifit total hip prostheses at a mean follow-up time of 11 (5-14) years. We found 23 (2.6%) fractures of the greater trochanter through a cystic lesion, occurring 4-11 years postoperatively. RESULTS: Nonoperative treatment healed 15 of the 17 fractures that were minimally displaced. At a mean follow-up of 3 (2-5) years after the fracture, 16 had had revision of the components because of excessive wear, loosening, or nonunion. INTERPRETATION: We conclude that a periprosthetic fracture of the greater trochanter through an osteolytic lesion is usually stable and heals without treatment. However, it is associated with poor prosthetic survival because of excessive polyethylene wear.

Adolescent↗

PubMed2005

Incidence and severity of biceps long head tendon lesion in patients with complete rotator cuff tears.

BACKGROUND: Biceps long head tendon lesion is commonly associated with rotator cuff tendon pathology. This study is to determine the pathologic spectrum of biceps long head tendon in surgical cases with complete full thickness rotator cuff tear. METHODS: Between 1993 and 2002, 122 complete rotator cuff tears with surgery were included for the analysis. During surgery, biceps long head tendon was grossly examined or evaluated via arthroscopy. A simplified classification was used to describe the biceps lesion. RESULTS: 50 (41%) patients had type 1 lesion (tendinitis), 10 (8%) patients had type 2 lesion (subluxation), 12 (10%) patients had type 3 (dislocation), 15 (12%) patients had type 4 (partial tear), and 6 patients (5%) had type 5 (complete rupture). The remaining 29 patients (24%) did not have obvious pathology. All chronic rotator cuff tear (> 3 months) were associated with biceps tendon pathology. A rotator cuff tear greater than 5 cm as determined at surgery was strongly associated with an advanced biceps lesion. CONCLUSION: Biceps tendon injuries are associated with complete rotator cuff tears and there may be a causal relationship due to the impingement that occurs. Early identification and repair of rotator cuff lesions may prevent further deterioration of the biceps tendon.

Adult↗

PubMed2005

Biomechanical comparison of newly designed stemless prosthesis and conventional hip prosthesis--an experimental study.

Local bone loss after implantation of traditional stem-type prostheses remains an unsolved problem during the long-term application of total hip replacement. The stress shielding effect and osteolysis were thought to be the two main factors that result in local bone loss after prosthesis implantation. A newly designed stemless cervico-trochanteric (C-T) prosthesis was thus developed to reduce stress shielding and osteolysis caused by the implantation of conventional stem-type prosthesis. Eight synthetic femora were implanted with C-T and porous coated anatomic (PCA) prostheses. Under 2,000-Newton load, the surface strains of proximal femora were compared between the intact, PCA press-fit femora and the C-T implanted femora with three different fixation modes: two-screw fixation, three-screw fixation, and three-screw combined with cement fixation. The results revealed that stress shielding in the C-T implanted femora was significantly eliminated compared to that of the PCA implanted femora (p<0.01). No statistical difference in strain magnitude was found for the C-T implanted femora among the three different fixation modes (p>0.1). The C-T implanted femur has more physiological strain distribution. Moreover, from the C-T prosthetic characteristic design, the localized osteolysis would be also reduced due to the overall coverage of neck-trochanteric area. The newly designed C-T prosthesis may be a useful alternative to the traditional stem-type prosthesis in the future.

Arthroplasty↗

PubMed2004

Arthroscopic anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft.

Tendon-bone incorporation of a tendon graft within the bone tunnel is of priority concern when using for anterior cruciate ligament (ACL) reconstruction. Superior healing process and stronger healing strength can be achieved when periosteum is sutured on the tendon inserted into a bone tunnel. We applied this idea to ACL reconstruction for enhancing tendon graft-bone tunnel healing. This is a prospective clinical outcome study with this surgical technique at minimal 2 years follow-up. Periosteum-enveloping hamstring tendon graft has been used in 68 patients. Data from 62 patients who had been followed up completely were analyzed. All patients suffered from a grade 3 or higher grade of Lachman and anterior drawer test with a positive pivot-shift test. Clinical assessments included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, KT-1000 instrumented testing, thigh muscle assessment, and radiographic evaluation. The median Lysholm knee score was 59 (40-70) and 94 (60-100) points (P<0.01) before and after surgery. After reconstruction, 81% of patients were able to return to moderate or strenuous activity. Four (6%) patients were found to exhibit grade 2 or more ligament laxity. Complete range of motion could be achieved in 86% of patients. Three patients (5%) had positive pivot shift. Finally, 92% of patients were assessed as normal or nearly normal rating by IKDC guideline. Bone tunnels enlargement of more than 1 mm was identified in 5% of femoral tunnels and 6% of tibial tunnels. The study shows that a satisfactory result can be achieved with the periosteum-enveloping hamstring tendon graft in ACL reconstruction. Periosteum can be easily harvested at the proximal tibia from a routine incision for hamstring tendon harvesting. Besides the potential for improving tendon-bone healing, enveloped periosteum may help to seal the intra-articular tunnel opening in the early postoperative period, and thus avoid synovial fluid reflux into the tunnel. Bone tunnel enlargement could be reduced.

Adolescent↗

PubMed2004

Selection of fixation devices in proximal femur rotational osteotomy: clinical complications and finite element analysis.

OBJECTIVE: To compare the postoperative stability between large cancellous screws fixation and dynamic hip screws fixation in transtrochanteric rotational osteotomy. DESIGN: Finite element analysis was designed to validate the clinical outcomes of fixation failure in transtrochanteric rotational osteotomy. BACKGROUND: From 1997 to 2000, transtrochanteric rotational osteotomy had been done in 20 osteonecrotic hips. Fixation with large cancellous screws as suggested by Sugioka had been used in the first five hips. Unfortunately, fixation failures were encountered in all of the five cases. The fixation mode was then shifted to a combination of plate and screws, no fixation failure had been observed postoperatively. A finite element analysis was designed to investigate the causes of fixation failure. METHODS: Finite element models for four dynamic hip screw instrumented femora and four large screws instrumented femora simulating four different levels of bone cut were created. The von Mises stress distributions of each model were analyzed and compared for a loading condition simulating single-legged stance. RESULTS: Analysis results confirmed our clinical observation that fixation with screws had higher stress concentration on the proximal femur. Improper bone cut, especially those that are too distal from the intertrochanteric line, had higher risks of fixation failure. CONCLUSIONS: Transtrochanteric rotational osteotomy is a technically demanding procedure such that surgical principles should be abided carefully to avoid catastrophic complications. RELEVANCE: Finite element analysis results demonstrated that dynamic hip screw fixation provides better stability and prevents fixation failure that corresponds with the clinical observation.

Adult↗

PubMed2004

Two-stage revision hip arthroplasty for infection with a custom-made, antibiotic-loaded, cement prosthesis as an interim spacer.

BACKGROUND: Two-stage reconstruction is a well-recognized treatment for deep infection of hip joint implants. The purpose of the study was to report the results of our treatment using a standardized protocol. METHODS: Forty-two consecutive patients with deep infection of the hip prosthesis were treated according to a prospective, two-stage resection/reimplantation protocol. Between stages, a custom-made, antibiotic-loaded, cement prosthesis was implanted as an interim spacer. RESULTS: Infection was eradicated in 41 patients after the first-stage operation. Thirty-six patients remained with the ability to walk with the interim cement pros-thesis. For 40 patients who underwent reimplantation, recurrence of infection was observed in only 1 patient at an average of 55.2 months' follow-up. CONCLUSION: We have found that our two-stage treatment protocol is a reliable approach for the management of infected hip prostheses. It is effective for eradicating infection and for providing a mobile and functional joint through the treatment course.

Adult↗

PubMed2004

Arthroscopic posterior cruciate ligament reconstruction with quadriceps tendon autograft: minimal 3 years follow-up.

BACKGROUND: Various autografts or allografts have been used for posterior cruciate ligament (PCL) reconstruction. Quadriceps tendon-patellar bone autograft is considered a good graft choice. HYPOTHESIS: Quadriceps tendon-patellar bone graft for PCL reconstruction can achieve a satisfactory clinical outcome after 3 years postoperatively. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: From 1996, the graft has been used in 32 patients. Twenty-nine patients with a minimum of 3 years of follow-up were analyzed. RESULTS: Twenty-four (83%) patients achieved good or excellent results by Lysholm knee rating. Sixteen (55%) patients could return to moderate or strenuous activity. Twenty-five (86%) patients had ligament laxity of less than 5 mm. Twenty-four (83%) patients were rated as normal or nearly normal by International Knee Documentation Committee (IKDC) guidelines. Twenty-four (83%) and 26 (90%) patients could achieve recovery of extensor and flexor muscle strength to 80% or more of normal knee, respectively. A statistically significant difference exists in thigh girth difference, extensor strength, and flexor strength before and after reconstruction. CONCLUSION: Our study revealed satisfactory clinical subjective and objective results at a minimum 3 years follow-up. Quadriceps tendon autograft has the advantage of being self-available, a relatively easier arthroscopic technique, and having a suitable size, making it an acceptable graft choice for PCL reconstruction.

Adult↗

PubMed2004

The influence of iliotibial tract on patellar tracking.

Thirty patients with 49 snapping hips and patellar malalignment underwent surgical release of the iliotibial tract contracture over the trochanteric area. Minimal follow-up was 2 years (average 4.6 years, range: 2-9 years). Eight patients underwent computed tomography (CT) preoperatively and 1 month postoperatively to investigate the patellar location in the patellofemoral articulation with knee bending at 0 degrees, 20 degrees, 45 degrees, 60 degrees, and 90 degrees. Significant improvements in the congruence angle and lateral patellofemoral angle were noted on Merchant radiograph for all knees (P<.01). On CT, at 20 degrees and 45 degrees knee bending, all congruence, lateral patellofemoral, and patellar tilt angles significantly improved postoperatively in 8 knees (P<.01). Iliotibial tract affects patellar tracking and dominates lateral patellar supporting structures.

Adult↗

PubMed2004

Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis.

BACKGROUND: A two-stage revision is a well-accepted method for the treatment of a deep infection of a hip with a joint implant. In the present study, the results associated with the interim use of antibiotic-loaded cement beads were compared with those associated with the interim use of an antibiotic-loaded cement prosthesis. METHODS: One hundred and twenty-eight consecutive patients who were managed with a two-stage revision hip arthroplasty for the treatment of an infection were followed clinically and radiographically for an average of 4.9 years. Cement beads were implanted following resection arthroplasty in the first seventy hips, and a custom cement prosthesis was implanted in the subsequent fifty-eight hips. RESULTS: There was no evidence of recurrent infection in 122 patients (95.3%); the infection-free rates in both groups were similar. The use of a spacer prosthesis was associated with a higher hip score, a shorter hospital stay, and better walking capacity in the interim period; a decreased operative time, less blood loss, and a lower transfusion requirement at the time of reimplantation; and fewer postoperative dislocations. CONCLUSIONS: The present study supports the safety and efficacy of the routine use of an antibiotic-loaded cement prosthesis in the interim between the stages of a two-stage revision procedure for the treatment of an infection at the site of a hip arthroplasty.

Adult↗