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Dynamischer vs. statischer Zementspacer in der Knietotalendoprotheseninfektion

Eine Metaanalyse

Dynamic versus static cement spacer in periprosthetic knee infection

A meta-analysis

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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.

Abstract

Background

The standard of care for treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is two-stage revision arthroplasty. The cement spacer in the interim period can be classified as either a static/non-articulating spacers (e.g., traditionally simple cement blocks) or a mobile/articulating spacer.

Objectives

The goal of the present meta-analysis is to analyze the outcomes with regard to infection control between dynamic and static knee spacers in the treatment of infected TKA with a minimum 3-year follow-up.

Materials and methods

We systematically reviewed the literature for potentially relevant articles addressing two-stage revision of an infected TKA using the MEDLINE computerized literature databases. Only 25 articles studies with a minimum follow-up examination of 36 months met the inclusion criteria and were analyzed with regard to infection control after reimplantation between static (318 cases) and dynamic group (700 cases).

Results

At latest follow-up, the eradication rate in the dynamic group was 89.7 % (range 63–100 %; SD 9.1) and in the static group 84.8 % (range 67–92.4 %; SD 7.8; p = 0.32). We are unable to comment on the Hospital for Special Surgery (HSS) Score  and complication rates between static and dynamic spacers because the majority of the studies did not report on this.

Conclusion

The data show that there are no differences regarding infection control between static and dynamic spacers in the treatment of infected TKA.

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Authors and Affiliations

  1. Orthopädische Chirurgie, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Deutschland

    Mustafa Citak, Musa Citak & Daniel Kendoff

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  1. Mustafa Citak
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  2. Musa Citak
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Correspondence to Mustafa Citak.

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Interessenkonflikt

Daniel Kendoff (Fa. Link, Hamburg und Zimmer, USA), Mustafa Citak und Musa Citak geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag enthält keine Studien an Menschen oder Tieren.

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Citak, M., Citak, M. & Kendoff, D. Dynamischer vs. statischer Zementspacer in der Knietotalendoprotheseninfektion. Orthopäde 44, 599–606 (2015). https://doi.org/10.1007/s00132-015-3091-2

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