| BackgroundWith the continuous popularity of total hip arthroplasty(THA),the impact of postoperative complications on the prognosis of patients has gradually emerged.Prosthetic-joint infections(PJI)are the most serious after THA One of the complications.According to statistics,the incidence of infection in patients undergoing total hip replacement for the first time is 1%,but the actual incidence may be higher,and the probability of infection in revision surgery can even reach 16%.As THA increases year by year,the number of cases around the prosthesis is also increasing,so PJI is still the focus of joint surgeon research.At present,the internationally recognized "gold standard" for the treatment of artificial hip joint PJI is two-stage revision surgery,that is,the infected prosthesis is removed in one stage and thoroughly debrided,and a new hip prosthesis is placed after the infection is controlled.Although this method minimizes the rate of infection recurrence,it usually requires two operations,and the patient’s hip mobility is poor during the two operations,and the joint is unstable.Therefore,the patient stays in bed for a long time during the open period,resulting in the hip capsule and surrounding Contracture of the soft tissue will cause inconvenience to the surgeon during the second revision.In order to solve these problems that occurred during the patients’ two operations,the antibiotic antibiotic cement temporary placeholder was born.In recent years,temporary placeholders made by traditional methods often have complications such as rupture or dislocation in the patient’s body,and patients have higher and higher requirements for hip function during the open period of the placeholder,considering 3D printing Because of its rapid,direct,precise and personalized characteristics,the technology has been widely used in clinics at present.Therefore,this new technology is applied to patients who need to undergo second-stage revision treatment after infection of artificial hip replacement.ObjectiveTo summarize the experience of using temporary prostheses made by 3D printing technology to treat infections after total hip arthroplasty(THA)during the second-stage revision surgery,to evaluate its effect and role in the second-phase revision of infections after treatment of artificial hip replacement.MethodsA total of 6 patients(6 hips)with temporary hip prosthesis using 3D printing were investigated from January 2017 to February 2019 in patients infected with hip replacement at Guangzhou First People’s Hospital.There were 1 male(1 hip)and 5 female(5 hips).These 6 patients all took out the infected prosthesis in the first phase and thoroughly debridement,implanted with 3D printing personalized temporary prosthesis,including metal temporary prosthesis and reinforced bone cement temporary prosthesis,including personalized steel Bone cement prostheses are made with stereo lithography apparatus(SLA)3D printed molds,which are used to shape reinforced bone cement during the operation;and personalized metal prostheses are made with selective laser melting(SLM))Direct 3D printing is completed.After the patient’s infection is under control,the temporary prosthesis is removed and implanted into the hip joint prosthesis.Temporary prostheses are aided by Computer Aided Design(CAD)and 3D printing technology.All 6 patients were followed up.Postoperative review of patients’ white blood cells(WBC),erythrocyte sedimentation rate(ESR),hypersensitive C-reactive protein(CRP)and procalcitonin(PCT)and other serum Learn the inflammation indicators to reflect the effectiveness of this temporary prosthesis to control infection;through the X-ray film of the hip frog position,observe whether the temporary prosthesis has dislocations,fractures and other complications after implantation,and understand the survival status of the prosthesis.Observe the patient’s function and satisfaction,and use the Harris score to assess hip function.ResultsThe average follow-up time of 6 patients was 11.2 months(3-18 months).The infection was effectively controlled after the implantation of temporary prosthesis in all patients and the average of 5.2(3-8)Two months after total hip replacement,no complications such as rupture and dislocation of temporary prosthesis occurred during the two operations.Those with no difficulty in removing the temporary prosthesis during the second-stage revision surgery had a patient satisfaction rate of 100%.The Harris hip score increased from an average of(34.7 ± 2.5)points before surgery and an average of(78.1 ± 3.1)points between intervals to an average of(81.3 ± 2.4)points at the last follow-up.The difference was statistically significant.After the second-stage revision to the last follow-up,no cases of hip infection recurrence and new infection occurred during the follow-up.ConclusionIn the second-stage revision of patients with infections around the prosthesis after artificial hip replacement,the use of 3D printed temporary prosthesis has the advantages of simple fabrication,high infection control rate,more functions to retain the hip joint,and no temporary prosthesis fracture or dislocations and other complications,high patient satisfaction rate and other advantages,.Patients can obtain more satisfactory short-term effects after the second-stage revision surgery. |
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