Выполнен анализ литературных данных о современных подходах к лечению инфекции, развившейся в исходе тотального эндопротезирования тазобедренного сустава. Приведены сведения о том, что золотым стандартом лечения остается двухстадийное ревизионное эндопротезирование с использованием спейсеров, выполненных из цемента, импрегнированного антибиотиком, что позволяет контролировать инфекцию в 90 % случаев. Одним из решающих факторов в благоприятном исходе такого осложнения является своевременная диагностика и активная ранняя хирургическая тактика ведения пациентов. Использование цементных и металло-цементных спейсеров при лечении пациентов после удаления эндопротеза позволяет сохранить возможность осевой нагрузки на конечность на время достижения ремиссии воспалительного процесса. Применение такого подхода позволяет уменьшить объем резекции костного ложа вертлужной впадины и бедренной кости при ревизионном эндопротезировании.
It was performed an analysis of published data on the current approaches to the treatment of infections that developed in the outcome of total hip arthroplasty. The data that the gold standard of treatment is a two-stage revision cases using spacers made of cement impregnated with antibiotic, which allows to control the infection in 90 % of cases. One of the decisive factors in the favorable outcome of this complication is timely diagnosis and early surgical active case management. The use of cement and metal-cement spacers for the treatment of patients after removal of the prosthesis allows to keep the possibility of axial load on the limb at the time of remission of the inflammatory process. Such an approach reduces the amount of resection osteotomy of the acetabulum, the femur in revision endoprosthesis.
1. Aхтямов И.Ф., Гарифуллов Г.Г. Новые способы профилактики интраоперационных и ранних послеоперационных осложнений при эндопротезировании тазобедренного сустава // Вестн. травматологии и ортопедии им. Н.Н. Приорова. - 2010. - № 1. - С. 25-28.
2. Дрягин В.Г., Атаманский И.А., Истомин С.Ю. и др. Асептическая нестабильность после эндопротезирвоания тазобедренного сустава // Вестн. травматологии и ортопедии им. В.Д. Чаклина. - 2009. - №1. - С. 25-28.
3. Николенко В.К., Буряченко Б.П., Давыдов Д.В. Особенности ревизионного эндопротезирования тазобедренного сустава по поводу инфекционных осложнений // Инфекции в хирургии. - 2008. - Т. 6, № 2. - С. 50-55.
4. Сакалов Д.А., Скороглядов А.Ф. Профилактика инфекционных осложнений при эндопротезировании тазобедренного сустава // Эндопротезирование в России: Всерос. монотематич. сб. науч. статей. - Казань; СПб., 2007. - Вып. 3. - С. 83-86.
5. American Academy of Orthopaedic Surgeons. Primary Total Hip and Total Knee Arthroplasty Projections to 2030. - Rosemont, IL: American Academy of Orthopaedic Surgeons, 1998.
6. Ammon P., Stockley I. Allograft bone in two-stage revision of the hip for infection. Is it safe? // J. Bone Joint Surg Br. - 2004. - Vol.86 (7). - P.962-965.
7. Anagnostakos K., Kohn D. Hip joint infections - Results of a questionnaire among 28 university orthopedic departments // Orthopade. - 2011. - Vol. 40 (9). - P.781-792.
8. Babiak I. Application of individually performed acrylic cement spacers containing 5% of antibiotic in two-stage revision of hip and knee prosthesis due to infection // Pol. Orthop. Traumatol. - 2012. - Vol.77. - P.29-37.
9. Barcia-Macay M., Lemaire S., Mingeot-Leclercq M.P. et al. Evaluation of the extracellular and intracellular activities (human THP-1 macrophages) of telavancin versus vancomycin against methicillin-susceptible, methicillin-resistant, vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus // J. Antimicrob. Chemother. - 2006. - Vol.58 (6). - P.1177-1184.
10. Ben-Lulu O., Farno A., Gross A.E. et al. A modified cement spacer technique for infected total hip arthroplasties with significant bone loss // J. Arthroplasty. - 2012. - Vol.27 (4). - P.613-619.
11. Bertazzoni Minelli E., Benini A., Magnan B., Bartolozzi P. Release of gentamicin and vancomycin from temporary human hip spacers in two-stage revision of infected arthroplasty // J. Antimicrob. Chemother. - 2004. - Vol. 53 (2). - P.329-334.
12. Burnett R.J., Kelly M.A., Hanssen A.D., Barrack R.L. Technique and Timing of Two-stage Exchange for Infection in TKA // Clinical Orthopaedics and Related Research. - 2007. - Vol. 464. - P.164-178.
13. Buttaro M.A., Gimenez M.I., Greco G. et al. High active local levels of vancomycin without nephrotoxicity released from impacted bone allografts in 20 revision hip arthroplasties // Acta Orthop. - 2005. - Vol.76 (3). - P.336-340.
14. Carulli C., Villano M., Civinini R. et al. A novel technique to preserve range of motion in two-stage revision of infected total knee arthroplasty // Int. Orthop. - 2013. - Vol.37 (6). - P.1069-1074.
15. Cassar Gheiti A.J., Baker J.F., Brown T.E., Mulhall K.J. Management of total femoral bone loss using a hybrid cement spacer surgical technique // J. Arthroplasty. - 2013. - Vol.28 (2). - P.347-351.
16. Dauchy F.A., Dupon M., Dutronc H. et al. Association between psoas abscess and prosthetic hip infection: a case-control study // Acta Orthop. - 2009. - Vol.80 (2). - P.198-200.
17. Deelstra J.J., Neut D., Jutte P.C. Successful treatment of Candida albicans-infected total hip prosthesis with staged procedure using an antifungal-loaded cement spacer // J. Arthroplasty. - 2013. - Vol.28 (2). - P.374.
18. Deresinski S. Counterpoint: Vancomycin and Staphylococcus aureus - an antibiotic enters obsolescence // Clin. Infect. Dis. - 2007. - Vol.44 (12). - P.1543-1548.
19. Diwanji S.R., Kong I.K., Park Y.H. et al. Two-Stage Reconstruction of Infected Hip Joints // The Journal of Arthroplasty. - 2008. - Vol. 23. - P.5.
20. Donegan D.J., Scolaro J., Matuszewski P.E., Mehta S. Staged bone grafting following placement of an antibiotic spacer block for the management of segmental long bone defects // Orthopedics. - 2011. - Vol. 34 (11). - P.730-735.
21. Duncan C.P., Beauchamp C. A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip // Orthop. Clin. North Am. - 1993. - Vol. 24. - P.751-759.
22. Dunne N., Hill J., McAfee P. et al. In vitro study of the efficacy of acrylic bone cement loaded with supplementary amounts of gentamicin: effect on mechanical properties, antibiotic release, and biofilm formation // Acta Orthop. - 2007. - Vol.78 (6). - P.774-785.
23. Edwards P.K., Fehring T.K., Hamilton W.G. et al. Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties? // Clin. Orthop. Relat. Res. - 2014. - Vol. 472 (1). - P.206-211.
24. Ensing G.T., Van Horn J.R., Van der Mei H.C. et al. Copal bone cement is more effective in preventing biofilm formation than Palacos R-G // Clin. Orthop. Relat. Res. - 2008. - Vol. 466. - P.1492-1498.
25. Fux C.A., Stoodley P., Hall-Stoodley L., Costerton J.W. Bacterial biofilms: a diagnostic and therapeutic challenge // Expert. Rev. Anti Infect. Ther. - 2003. - Vol.1 (4). - P.667-683.
26. Gallazzi M.B., Chiapparino R., Garbagna P.G. Early Radiological Diagnosis of Infection in Orthopaedic Surgery // Infection and Local Treatment in Orthopedic Surgery. - Berlin; Heidelberg: Springer-Verlag, 2007. - P. 21-32.
27. Garazzino S., Aprato A., Baietto L. et al. Glycopeptide bone penetration in patients with septic pseudoarthrosis of the tibia // Clin. Pharmacokinet. - 2008. - Vol.47 (12). - P.793-805.
28. Garg P., Ranjan R., Bandyopadhyay U. et al. Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty // Indian J. Orthop. - 2011. - Vol.45 (6). - P.535-540.
29. Hanssen A.D., Spangehl M.J. Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements // Clinical Orthopaedics and Related Research. - 2004. - Vol. 427. - P.79-85.
30. Hsieh P.H., Huang K.C., Tai C.L. Liquid gentamicin in bone cement spacers: in vivo antibiotic release and systemic safety in two-stage revision of infected hip arthroplasty // Journal of Trauma. - 2009. - Vol.66 (3). - P.804-808.
31. Ikeuchi M., Okanoue Y., Izumi M. et al. Diagnostic value of triple-phase bone scintigraphy for the diagnosis of infection around antibiotic-impregnated cement spacers // Springerplus. - 2013. - Vol.27 (2). - P.401.
32. Jefferson K.K., Goldmann D.A., Pier G.B. Use of confocal microscopy to analyze the rate of vancomycin penetration through Staphylococcus aureus biofilms // Antimicrob. Agents Chemother. - 2005. - Vol.49 (6). - P.2467-2473.
33. Khoo P.P.C., Michalak K.A., Yates P.J. et al. Iontophoresis of antibiotics into segmental allografts // J. Bone Joint. Surg. Br. - 2006. - Vol.88. - P.1149-1157.
34. Kundu Z.S., Gogna P., Gupta V. et al. Proximal humeral reconstruction using nail cement spacer in primary and metastatic tumours of proximal humerus // Strategies Trauma Limb Reconstr. - 2013. - Vol.8 (3). - P.149-154.
35. Magnan B., Bondi M., Maluta T. et al. Acrylic bone cement: current concept review // Musculoskelet. Surg. - 2013. - Vol.97 (2). - P.93-100.
36. Manzi G., Romano D., Moneghini L., Romano C.L. Successful staged hip replacement in septic hip osteoarthritis in osteopetrosis: a case report // BMC Musculoskelet Disord. - 2012. - Vol.13. - P.50.
37. Marrie T.J., Costerton J.W. Mode of growth of bacterial pathogens in chronic polymicrobial human osteomyelitis // J. Clin Microbiol. - 1985. - Vol.22 (6). - P.924-933.
38. Melamed E.A., Peled E. Antibiotic impregnated cement spacer for salvage of diabetic osteomyelitis // Foot Ankle Int. - 2012. - Vol.33 (3). - P.213-219.
39. Murray W.R. Use of antibiotic-containing bone cement // Clin. Orthop. - 1984. - Vol.190. - P.89-95.
40. Nelson C.L., McLaren A.C., McLaren S.G. et al. Is aseptic loosening truly aseptic? // Clin. Orthop. Relat. Res. - 2005. - Vol. 437. - P.25-30.
41. Neut D., Van der Mei H.C., Bulstra S.K., Busscher H.J. The role of small-colony variants in failure to diagnose and treat biofilm infections in orthopedics // Orthop. - 2007. - Vol.78 (3). - P.299-308.
42. Penner M.J., Duncan C.P., Masri B.A. The in vitro elution characteristics of antibiotic-loaded CMW and Palacos-R bone cements // J. Arthroplasty. - 1999. - Vol.14. - P.209-214.
43. Qazi S.N., Harrison S.E., Self T. et al. Real-time monitoring of intracellular Staphylococcus aureus replication // J. Bacteriol. - 2004. - Vol.186 (4). - P.1065-1077.
44. Saginur R., Stdenis M., Ferris W. et al. Multiple combination bactericidal testing of staphylococcal biofilms from implant-associated infections // Antimicrob. Agents Chemother. - 2006. - Vol.50 (1). - P.55-61.
45. Smith A.W. Biofilms and antibiotic therapy: is there a role for combating bacterial resistance by the use of novel drug delivery systems? // Adv. Drug. Deliv. Rev. - 2005. - Vol.57 (10). - P.1539-1550.
46. Struelens B., Claes S., Bellemans J. Spacer-related problems in two-stage revision knee arthroplasty // Acta Orthop. Belg. - 2013. - Vol.79 (4). - P.422-426.
47. Tunney M.M., Dunne N., Einarsson G. et al. Biofilm formation by bacteria isolated from retrieved failed prosthetic hip implants in an in vitro model of hip arthroplasty antibiotic prophylaxis // J. Orthop. Res. - 2007. - Vol.25 (1). - P.2-10.
48. Villemagne T., Bonnard C., Accadbled F. et al. Intercalary segmental reconstruction of long bones after malignant bone tumor resection using primary methyl methacrylate cement spacer interposition and secondary bone grafting: the induced membrane technique // J. Pediatr. Orthop. - 2011. - Vol.31 (5). - P.570-576.
49. Wan Z., Karim A., Momaya A. et al. Preformed articulating knee spacers in 2-stage total knee revision arthroplasty: minimum 2-year follow-up // J. Arthroplasty. - 2012. - Vol.27 (8). - P.1469-1473.