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Erschienen in: Der Orthopäde 8/2015

01.08.2015 | Übersicht

Dynamischer vs. statischer Zementspacer in der Knietotalendoprotheseninfektion

Eine Metaanalyse

verfasst von: Dr. Mustafa Citak, Musa Citak, Daniel Kendoff

Erschienen in: Die Orthopädie | Ausgabe 8/2015

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Zusammenfassung

Hintergrund

Bei chronischem periprothetischen Infekt des Kniegelenks ist der zweizeitige Prothesenwechsel als Goldstandard anzusehen. Der Zementspacer in der Interimsphase kann entweder als statischer/nicht artikulierender Spacer (z. B. traditioneller Zementblock) oder als dynamischer/artikulierender Spacer klassifiziert werden.

Fragestellung

Das Ziel der vorliegenden Metaanalyse ist herauszuarbeiten, ob Unterschiede für dynamische und statische antibiotikabeladene Zementspacer in der Therapie des periprothetischen Infekts des Kniegelenks mit mindestens 3 Jahren Nachuntersuchungszeitraum nach erfolgter Reimplantation existieren.

Material und Methoden

Mit Hilfe der elektronischen Datenbank „MEDLINE“ führten wir eine systematische Literaturrecherche durch. In unsere Analyse wurden nur Studien mit einem Nachuntersuchungszeitraum von mindestens 36 Monaten nach Reimplantation eingeschlossen (25 Artikel) und wurden hinsichtlich der Eradikationsrate analysiert.

Ergebnisse

Insgesamt wurden 1018 Fälle (700 dynamische, 318 statische) mit periprothetischen Knieinfekten in unsere Studie mit einem im Minimum 3-Jahres Nachuntersuchungszeitraum eingeschlossen. Es fanden sich keine signifikanten Unterschiede für die Eradikationsrate (p = 0,32) zwischen statischen und dynamischen Spacern.

Schlussfolgerung

Schlussfolgernd zeigen unsere Daten, dass keine Unterschiede für die Infektkontrolle zwischen statischen und dynamischen Spacern in der Therapie des chronischen periprothetischen Infekts des Kniegelenks existieren.
Literatur
1.
Zurück zum Zitat Anderson JA, Sculco PK, Heitkemper S et al (2009) An articulating spacer to treat and mobilize patients with infected total knee arthroplasty. J Arthroplasty 24:631–635CrossRefPubMed Anderson JA, Sculco PK, Heitkemper S et al (2009) An articulating spacer to treat and mobilize patients with infected total knee arthroplasty. J Arthroplasty 24:631–635CrossRefPubMed
2.
Zurück zum Zitat Blom AW, Brown J, Taylor AH et al (2004) Infection after total knee arthroplasty. J Bone Joint Surg Br 86:688–691CrossRefPubMed Blom AW, Brown J, Taylor AH et al (2004) Infection after total knee arthroplasty. J Bone Joint Surg Br 86:688–691CrossRefPubMed
3.
Zurück zum Zitat Chiang ER, Su YP, Chen TH et al (2011) Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty. Acta Orthop 82:460–464PubMedCentralCrossRefPubMed Chiang ER, Su YP, Chen TH et al (2011) Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty. Acta Orthop 82:460–464PubMedCentralCrossRefPubMed
4.
Zurück zum Zitat Choi HR, Malchau H, Bedair H (2012) Are prosthetic spacers safe to use in 2-stage treatment for infected total knee arthroplasty? J Arthroplasty 27:1474–1479, e1471CrossRefPubMed Choi HR, Malchau H, Bedair H (2012) Are prosthetic spacers safe to use in 2-stage treatment for infected total knee arthroplasty? J Arthroplasty 27:1474–1479, e1471CrossRefPubMed
5.
Zurück zum Zitat Citak M, Argenson JN, Masri B et al (2014) Spacers. J Orthop Res 32(Suppl 1):120–129 Citak M, Argenson JN, Masri B et al (2014) Spacers. J Orthop Res 32(Suppl 1):120–129
7.
Zurück zum Zitat Emerson RH Jr, Muncie M, Tarbox TR et al (2002) Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res 404:132–138CrossRefPubMed Emerson RH Jr, Muncie M, Tarbox TR et al (2002) Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res 404:132–138CrossRefPubMed
8.
Zurück zum Zitat Fehring TK, Odum S, Calton TF et al (2000) Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award. Clin Orthop Relat Res 380:9–16CrossRefPubMed Fehring TK, Odum S, Calton TF et al (2000) Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award. Clin Orthop Relat Res 380:9–16CrossRefPubMed
9.
Zurück zum Zitat Garg P, Ranjan R, Bandyopadhyay U et al (2011) Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty. Indian J Orthop 45:535–540PubMedCentralCrossRefPubMed Garg P, Ranjan R, Bandyopadhyay U et al (2011) Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty. Indian J Orthop 45:535–540PubMedCentralCrossRefPubMed
10.
Zurück zum Zitat Gooding CR, Masri BA, Duncan CP et al (2011) Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res 469:985–993PubMedCentralCrossRefPubMed Gooding CR, Masri BA, Duncan CP et al (2011) Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res 469:985–993PubMedCentralCrossRefPubMed
11.
Zurück zum Zitat Haddad FS, Masri BA, Campbell D et al (2000) The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br 82:807–812CrossRefPubMed Haddad FS, Masri BA, Campbell D et al (2000) The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br 82:807–812CrossRefPubMed
12.
Zurück zum Zitat Haleem AA, Berry DJ, Hanssen AD (2004) Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res 428:35–39CrossRefPubMed Haleem AA, Berry DJ, Hanssen AD (2004) Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res 428:35–39CrossRefPubMed
13.
Zurück zum Zitat Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122PubMed Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122PubMed
14.
Zurück zum Zitat Hart WJ, Jones RS (2006) Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy. J Bone Joint Surg Br 88:1011–1015CrossRefPubMed Hart WJ, Jones RS (2006) Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy. J Bone Joint Surg Br 88:1011–1015CrossRefPubMed
15.
Zurück zum Zitat Hofmann AA, Goldberg T, Tanner AM et al (2005) Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res 430:125–131CrossRefPubMed Hofmann AA, Goldberg T, Tanner AM et al (2005) Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res 430:125–131CrossRefPubMed
17.
Zurück zum Zitat Hsu YC, Cheng HC, Ng TP et al (2007) Antibiotic-loaded cement articulating spacer for 2-stage reimplantation in infected total knee arthroplasty: a simple and economic method. J Arthroplasty 22:1060–1066CrossRefPubMed Hsu YC, Cheng HC, Ng TP et al (2007) Antibiotic-loaded cement articulating spacer for 2-stage reimplantation in infected total knee arthroplasty: a simple and economic method. J Arthroplasty 22:1060–1066CrossRefPubMed
18.
Zurück zum Zitat Hsu CS, Hsu CC, Wang JW et al (2008) Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J 31:583–591PubMed Hsu CS, Hsu CC, Wang JW et al (2008) Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J 31:583–591PubMed
19.
Zurück zum Zitat Huang HT, Su JY, Chen SK (2006) The results of articulating spacer technique for infected total knee arthroplasty. J Arthroplasty 21:1163–1168CrossRefPubMed Huang HT, Su JY, Chen SK (2006) The results of articulating spacer technique for infected total knee arthroplasty. J Arthroplasty 21:1163–1168CrossRefPubMed
20.
Zurück zum Zitat Hwang BH, Yoon JY, Nam CH et al (2012) Fungal peri-prosthetic joint infection after primary total knee replacement. J Bone Joint Surg Br 94:656–659CrossRefPubMed Hwang BH, Yoon JY, Nam CH et al (2012) Fungal peri-prosthetic joint infection after primary total knee replacement. J Bone Joint Surg Br 94:656–659CrossRefPubMed
21.
Zurück zum Zitat Johnson AJ, Sayeed SA, Naziri Q et al (2012) Minimizing dynamic knee spacer complications in infected revision arthroplasty. Clin Orthop Relat Res 470:220–227PubMedCentralCrossRefPubMed Johnson AJ, Sayeed SA, Naziri Q et al (2012) Minimizing dynamic knee spacer complications in infected revision arthroplasty. Clin Orthop Relat Res 470:220–227PubMedCentralCrossRefPubMed
22.
Zurück zum Zitat Lee JK, Choi CH (2012) Two-stage reimplantation in infected total knee arthroplasty using a re-sterilized tibial polyethylene insert and femoral component. J Arthroplasty 27:1701–1706, e1701CrossRefPubMed Lee JK, Choi CH (2012) Two-stage reimplantation in infected total knee arthroplasty using a re-sterilized tibial polyethylene insert and femoral component. J Arthroplasty 27:1701–1706, e1701CrossRefPubMed
23.
Zurück zum Zitat Macheras GA, Kateros K, Galanakos SP et al (2011) The long-term results of a two-stage protocol for revision of an infected total knee replacement. J Bone Joint Surg Br 93:1487–1492CrossRefPubMed Macheras GA, Kateros K, Galanakos SP et al (2011) The long-term results of a two-stage protocol for revision of an infected total knee replacement. J Bone Joint Surg Br 93:1487–1492CrossRefPubMed
24.
Zurück zum Zitat Macmull S, Bartlett W, Miles J et al (2010) Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability. Knee 17:403–406CrossRefPubMed Macmull S, Bartlett W, Miles J et al (2010) Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability. Knee 17:403–406CrossRefPubMed
25.
Zurück zum Zitat Meek RM, Masri BA, Dunlop D et al (2003) Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer. J Bone Joint Surg Am 85-A:1888–1892PubMed Meek RM, Masri BA, Dunlop D et al (2003) Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer. J Bone Joint Surg Am 85-A:1888–1892PubMed
26.
Zurück zum Zitat Meek RM, Dunlop D, Garbuz DS et al (2004) Patient satisfaction and functional status after aseptic versus septic revision total knee arthroplasty using the PROSTALAC articulating spacer. J Arthroplasty 19:874–879CrossRefPubMed Meek RM, Dunlop D, Garbuz DS et al (2004) Patient satisfaction and functional status after aseptic versus septic revision total knee arthroplasty using the PROSTALAC articulating spacer. J Arthroplasty 19:874–879CrossRefPubMed
27.
Zurück zum Zitat Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097PubMedCentralCrossRefPubMed Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097PubMedCentralCrossRefPubMed
28.
Zurück zum Zitat Peersman G, Laskin R, Davis J et al (2001) Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 392:15–23CrossRefPubMed Peersman G, Laskin R, Davis J et al (2001) Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 392:15–23CrossRefPubMed
29.
Zurück zum Zitat Phillips JE, Crane TP, Noy M et al (2006) The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 88:943–948CrossRefPubMed Phillips JE, Crane TP, Noy M et al (2006) The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 88:943–948CrossRefPubMed
30.
Zurück zum Zitat Pivec R, Naziri Q, Issa K et al (2014) Systematic review comparing static and articulating spacers used for revision of infected total knee arthroplasty. J Arthroplasty 29:553–557, e551CrossRefPubMed Pivec R, Naziri Q, Issa K et al (2014) Systematic review comparing static and articulating spacers used for revision of infected total knee arthroplasty. J Arthroplasty 29:553–557, e551CrossRefPubMed
31.
Zurück zum Zitat Qiu XS, Sun X, Chen DY et al (2010) Application of an articulating spacer in two-stage revision for severe infection after total knee arthroplasty. Orthop Surg 2:299–304CrossRefPubMed Qiu XS, Sun X, Chen DY et al (2010) Application of an articulating spacer in two-stage revision for severe infection after total knee arthroplasty. Orthop Surg 2:299–304CrossRefPubMed
32.
Zurück zum Zitat Soohoo NF, Lieberman JR, Ko CY et al (2006) Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am 88:480–485CrossRefPubMed Soohoo NF, Lieberman JR, Ko CY et al (2006) Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am 88:480–485CrossRefPubMed
33.
Zurück zum Zitat Su YP, Lee OK, Chen WM et al (2009) A facile technique to make articulating spacers for infected total knee arthroplasty. J Chin Med Assoc 72:138–145CrossRefPubMed Su YP, Lee OK, Chen WM et al (2009) A facile technique to make articulating spacers for infected total knee arthroplasty. J Chin Med Assoc 72:138–145CrossRefPubMed
34.
Zurück zum Zitat Thabe H, Schill S (2007) Two-stage reimplantation with an application spacer and combined with delivery of antibiotics in the management of prosthetic joint infection. Oper Orthop Traumatol 19:78–100CrossRefPubMed Thabe H, Schill S (2007) Two-stage reimplantation with an application spacer and combined with delivery of antibiotics in the management of prosthetic joint infection. Oper Orthop Traumatol 19:78–100CrossRefPubMed
35.
Zurück zum Zitat Tigani D, Trisolino G, Fosco M et al (2013) Two-stage reimplantation for periprosthetic knee infection: influence of host health status and infecting microorganism. Knee 20:9–18CrossRefPubMed Tigani D, Trisolino G, Fosco M et al (2013) Two-stage reimplantation for periprosthetic knee infection: influence of host health status and infecting microorganism. Knee 20:9–18CrossRefPubMed
36.
Zurück zum Zitat Voleti PB, Baldwin KD, Lee GC (2013) Use of static or articulating spacers for infection following total knee arthroplasty: a systematic literature review. J Bone Joint Surg Am 95:1594–1599CrossRefPubMed Voleti PB, Baldwin KD, Lee GC (2013) Use of static or articulating spacers for infection following total knee arthroplasty: a systematic literature review. J Bone Joint Surg Am 95:1594–1599CrossRefPubMed
Metadaten
Titel
Dynamischer vs. statischer Zementspacer in der Knietotalendoprotheseninfektion
Eine Metaanalyse
verfasst von
Dr. Mustafa Citak
Musa Citak
Daniel Kendoff
Publikationsdatum
01.08.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Orthopädie / Ausgabe 8/2015
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-015-3091-2

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