Punt, R.A. (Renée) (2020) Mid to long-term outcome of a surgeon-fabricated mega-spacers in two-stage infection treatment: A solution for gross segmental defects. thesis, Medicine.
Full text available on request.Abstract
Background: Peri-prosthetic joint infection (PJI) and infection after fracture fixation (IAFF) are serious complications that can occur after arthroplasty surgery or open reduction of a fracture. In some cases the infection is so extensive that it necessitates resection of segments of bone. In this case a two-stage revision utilizing a mega-spacer can be opted for. However, not much is known about the outcome of this treatment. Therefore, the aim is to report on intermediate to long-term outcomes of this treatment. Method: In this retrospective case series 36 patients that underwent a two-stage revision for PJI or IAFF with a segmental defect were included. Minimum follow-up period was two years after reimplantation. The primary outcome was patient survival. Secondary outcomes were reimplantation rate, infection eradication rate and complication rate. Additionally, patient-reported outcomes were reported for 21 patients that filled out a survey in which they reported on pain and satisfaction, amongst others. Results: Patient survival at two and five-year follow-up after reimplantation was 81% and 68%. Limb survival was 98% at two and five years. Reimplantation occurred in 83.3%. Infection eradication rate was 52.8%. A complication with the spacer was observed in 19,4%. Mean numeric rating scale satisfaction score for the treatment was 6.6 out of 10 as rated by the 21 survey respondents. Conclusion: Two-stage treatment of PJI and IAFF with segmental defects is a valuable limb saving treatment. Mortality and complication rates in this cohort are comparable to those reported in studies of two-stage revisions for PJI without segmental defects. Additionally, good patient satisfaction was reported. However, infection eradication in our case series and literature on two-stage revision is low. Additional attention should be directed towards infection eradication with additional attention for infections with a chronic course.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Ploegmakers, Dr. J.J.W. and Gorter, J. |
| Faculty: | Medical Sciences |
| Date Deposited: | 20 Dec 2021 11:06 |
| Last Modified: | 20 Dec 2021 11:12 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2887 |
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