Case report
How to create by your own a customized hip cement mega-spacer for a hip megaprosthesis two-stage revision surgery after oncologic limb-salvage surgery – Surgical technique and case report
¿Cómo crear un megaespaciador personalizado para una cirugía de revisión en 2 tiempos de megaprótesis de cadera después de una cirugía de salvamento de extremidad por causa oncológica? - Técnica quirúrgica y reporte de 2 casos
M. Fa-Binefa, M. Valera Pertegás, A. Peiró Ibañez, L. Trullols Tarragó, P. Machado Granados, I. Gracia Alegría
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Orthopedic Oncology Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Fa-Binefa, M. Valera Pertegás, A. Peiró Ibañez, L. Trullols Tarragó, P. Machado Granados, I. Gracia Alegría" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Fa-Binefa" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Valera Pertegás" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Peiró Ibañez" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Trullols Tarragó" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Machado Granados" ] 5 => array:4 [ "nombre" => "I." "apellidos" => "Gracia Alegría" "email" => array:1 [ 0 => "igracia@santpau.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Orthopedic Oncology Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Cómo crear un megaespaciador personalizado para una cirugía de revisión en 2 tiempos de megaprótesis de cadera después de una cirugía de salvamento de extremidad por causa oncológica? - Técnica quirúrgica y reporte de 2 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1600 "Ancho" => 2674 "Tamanyo" => 420479 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Customized hip cement mega-spacer for a hip megaprosthesis septic two-stage revision surgery after osteogenic osteoblastic sarcoma (preoperative, 1st stage, spacer and 2nd stage).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Advancements in the treatment of malignant bone tumors and progress in chemotherapy and radiation therapies have led to an increased demand for limb-salvage surgeries, which often involve the use of a megaprosthesis following surgical resection.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> Megaprosthesis surgical implants exhibit higher complication rates compared to standard hip or hip revision surgeries. Factors such as patient life expectancy, implant design, pathologic soft tissue resection, and accompanying treatments can contribute to infection rates averaging 15–37%.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> Addressing megaprosthesis infection typically involves a multidisciplinary approach, incorporating follow-ups with an infectious disease team, antibiotics, and two-stage revision surgeries with cement spacers.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> Preformed antibiotic spacers have demonstrated improved surgical outcomes in terms of surgery duration, complication rate, and infection eradication in total hip arthroplasty.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> However, such data has not been extensively studied in oncologic patients. Moreover, due to the unique characteristics and relatively infrequent use of megaprosthesis, specific preformed spacers might not always be available or in stock for surgeries that cannot always be delayed.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of this paper is to detail a replicable and accessible technique to assemble a tailored cement-spacer for hip megaprosthesis. This technique can accommodate and adjust to various modular components and bone stock availability, assisting surgical teams with the complex challenge of hip megaprosthesis infections after bone tumor surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Surgical technique</span><p id="par0015" class="elsevierStylePara elsevierViewall">To create the custom cement spacer for a hip megaprosthesis, the following items are needed: (1) explanted stem, (2) specific hip cement spacer, (3) Steinmann's pins, (4) metal banding x2, and (4) plastic tubes (syringe, others).</p><p id="par0020" class="elsevierStylePara elsevierViewall">After surgical explant we will have the available length and width of the hip megaprosthesis stem in the different modular/interface levels.</p><p id="par0025" class="elsevierStylePara elsevierViewall">First, we tried the optimal head measure for the different hip commercial cement spacers available. In our case we used the hip stem cement spacer <span class="elsevierStyleItalic">Vancogenx Space Hip XL Flat System</span> (Tecres SPA).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Then, we measured the distance from the stem tip to the first module-width and from the first module-width to the second module-width interfaces and marked these same distances in the hip cement spacer.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After that, we added two 6<span class="elsevierStyleHsp" style=""></span>mm Steinmann's pins in each side of the cement spacer, with a 10<span class="elsevierStyleHsp" style=""></span>cm superposition with the preformed cement spacer stem and blocked them to the cement stem with two proximal metallic bands.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Once, we used the sterile container tube of a thoracic catheter (Argyle – Thoracic Catheter – Covidien) which has same with as the original distal megaprosthesis stem. However other plastic tubular structures available in the surgery room, such as syringes can be used. This structure can vary depending on required width and available structures but must be wider than new width of the distal stem with added Steinmann. Steinmann can be <<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mm in cases with thinner stems.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Afterwards that we introduce the tubular plastic structure until the first marked width-change marked interface from the original megaprosthesis. A transparent dressing or a glove can be used to fix it proximally and avoid leaks. Distal tube is cut according to surgeon preferences and distal bone stock available.</p><p id="par0050" class="elsevierStylePara elsevierViewall">We proceed with the antibiotic-based cementation from the distal tube opening. When cementation process is finished, we remove external plastic cover with a blade.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Then, we used a 60<span class="elsevierStyleHsp" style=""></span>ml-syringe with similar width to the original proximal module of the megaprosthesis, also using a dressing or a glove to fix it proximally and avoid leaks.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Finally, as that diaphysis are usually wider than healthy ones, we proceed again with same cementation process. If needed, a distal cement crown can be hand added in situ to give extra support.</p><p id="par0065" class="elsevierStylePara elsevierViewall">This method facilitates the undertaking of a first-stage megaprosthesis revision surgery in the context of infections specific to hip megaprosthesis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case report and outcomes</span><p id="par0070" class="elsevierStylePara elsevierViewall">Two cases of first-stage septic hip megaprosthesis revision surgery are documented. Both patients suffered periprosthetic infections with a tumor prosthesis initially implanted as a reconstructive measure after a proximal femur resection for limb-sparing surgery of bone sarcoma.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case report 1</span><p id="par0075" class="elsevierStylePara elsevierViewall">Man 62yo, with hypertension and smoking history, choroid melanoma 10 years ago, was diagnosed 6 years ago of a proximal femur II/III chondrosarcoma requiring surgical treatment with marginal resection and a double mobility hip megaprosthesis. Postoperative radiotherapy was done for 6 months with no evidence of periprosthetic infection or tumor recurrence. In the following years, he was diagnosed of loosening requiring revision surgery with negative intraoperative cultures. After 2 months, he presented in the emergency room with tenderness, increased CRP, and he was diagnosed of subacute surgical site infection with negative cultures for <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> requiring two-stage surgical revision. A customized hip antibiotic-loaded cement mega-spacer was used for the first stage of revision surgery as presented. Three months after that, in the 2nd stage revision surgery a revision mega prosthesis was implanted. Follow up, with long term suppressive antibiotic treatment, evolved with no other incidences (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Case report 2</span><p id="par0080" class="elsevierStylePara elsevierViewall">Women 21yo, with no previous pathology was diagnosed of a femoral osteogenic osteoblastic sarcoma. Patient started neoadjuvant chemotherapy and required resection tumor surgery with hip mega prosthesis reconstruction. In the immediate postoperative patient required embolization of medial gluteal artery. Postoperatively, surgical wound was associated to drainage, evolving to a fistula with positive cultures to <span class="elsevierStyleItalic">S. epidermidis</span> and starting antibiotherapy. During the following months she presented to emergency room twice with hip megaprosthesis dislocations and was proposed for a two-stage revision surgery. A customized hip antibiotic-loaded cement mega-spacer was used for the first stage of revision surgery as presented (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Three months after that, in the 2nd stage revision surgery a revision mega prosthesis was implanted. Follow up, with long term suppressive antibiotic treatment, evolved with no other incidences.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Cement spacers play a pivotal role in two-stage revision surgical techniques, with various researchers and literature exploring numerous means to adapt their use in hip and knee periprosthetic infections. Preformed or modeled cement spacers are reported to reduce complications in comparison to non-molded handmade spacers<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> and some factors such as spacer design, acetabular and femoral bone loss, offset restoration have been significantly associated with perioperative spacer complications in two-stage revision surgeries.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> However, modeled cement spacers are not always accessible or available.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Previous literature suggested multiple options of customized handmade techniques for hip cement-spacers with good outcomes including: intraoperative articular knee cement spacer for knee revision surgeries,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> acetabular defect cement spacer cover for hip revision surgeries with acetabular defects,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> hip cement spacers made with dental silicone templates for total hip revision surgery<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> and reverse hip prefabricated spacer for knee revision surgery with massive bone defects.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> Some authors also proposed alternative techniques including metallic implants combined with cement spacers with good results including: hip arthroplasty revision surgery with Steinmann pins,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> hip arthroplasty revision surgery with reconstruction plates mixed with acetabular cement-ball,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> knee revision surgery with intramedullary stabilized antibiotic spacers in patients with large segmental defects<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> and total femur prosthesis cement spacers.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Despite the promising potential of antibiotic-loaded cement in cement spacers as part of the treatment regimen for periprosthetic joint infections,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> their efficacy against infection remains ambiguous.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> One major complication of two-stage revision surgery due to infections, is THA dislocation, reported in up to 8.9% of cases at 1 year follow up.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> The rate is potentially higher for megaprosthesis, considering the increased soft tissue damage due to pathology and surgery.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Nevertheless, there's a paucity of literature specifically addressing oncologic limb-salvage surgery with megaprosthesis. Most decision-making inputs come from literature on prosthetic revision surgery, experiential insights, or case series reports.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This technique empowers surgical resources of an orthopedic team to conduct a two-stage revision surgery. The straightforward, cost-effective, and accessible surgical technique allows for the creation of an intramedullary metal-stabilized mega-cement spacer for patients who have undergone limb-salvage megaprosthesis surgery following an oncologic bone tumor resection.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Level of evidence</span><p id="par0110" class="elsevierStylePara elsevierViewall">Level of evidence IV.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">This research has not received specific aid from public sector agencies, commercial sectors or non-profit entities.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2081810" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1775992" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2081809" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1775991" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Surgical technique" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Case report and outcomes" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Case report 1" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Case report 2" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Level of evidence" ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-11-06" "fechaAceptado" => "2024-01-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1775992" "palabras" => array:6 [ 0 => "Hip megaprosthesis" 1 => "Arthroplasty" 2 => "Surgical oncology" 3 => "Reoperation" 4 => "Prosthesis-related infections" 5 => "Cement spacers" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1775991" "palabras" => array:6 [ 0 => "Megaprótesis de cadera" 1 => "Artroplastia" 2 => "Oncología quirúrgica" 3 => "Reintervención quirúrgica" 4 => "Infecciones relacionadas con prótesis" 5 => "Espaciadores de cemento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Managing chronic periprosthetic infections in patients who have undergone limb-salvage surgery following a malignant bone tumor with megaprosthesis often involves a two-stage revision surgery with the use of a cement-spacer. This paper show details the preparation of a self-made intramedullary metal-stabilized mega-cement spacer for patients needing a two-stage revision surgery due to infection after oncologic bone tumor resection and limb-salvage surgery with megaprosthesis and present two clinical cases treated with this technique. The report provides a practical surgical technique to create a cement hip mega-spacer using readily available tools in most orthopedic surgical settings.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El manejo de las infecciones periprotésicas crónicas en pacientes que han sido sometidos a cirugía de salvamento de extremidades mediante megaprótesis por un tumor maligno óseo a menudo implica una cirugía de revisión en 2 tiempos con el uso de un espaciador de cemento. Este artículo detalla la técnica quirúrgica para la creación de un megaespaciador de cemento con estabilización rígida intramedular y muestra 2 casos clínicos tratados con esta técnica de pacientes que necesitan una cirugía de revisión en 2 tiempos debido a una infección tras la resección del tumor óseo oncológico y cirugía de salvamento de extremidades con megaprótesis. Este texto proporciona una técnica quirúrgica sencilla y accesible para la creación de un megaespaciador de cadera de cemento utilizando herramientas disponibles en la mayoría de los quirófanos de nuestro entorno.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">Orthopedic Oncology Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.</span></p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1452 "Ancho" => 2674 "Tamanyo" => 620686 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Customized hip cement mega-spacer for a hip megaprosthesis two-stage revision surgery. (1) Material, (2) measure first interphase, (3) Steinman cerclage no. 1, (4) Steinman cerclage no. 2, (5) hip spacer – Steinman construct, (6) measure check, (7) cut according to measurement, (8) glove cement stop, (9) first interphase cementation, (10) plastic tub extraction, (11) preparation of second interphase cementation, (12) dressing cement stop, (13) second interphase cementation, (14) cemented second interphase, (15) syringe tub cut, and (16) final result comparted to explanted megaprosthesis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1756 "Ancho" => 2674 "Tamanyo" => 328105 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Customized hip cement mega-spacer for a hip megaprosthesis septic two-stage revision surgery after proximal femur chondrosarcoma (preoperative, 1st stage, and 2nd stage).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1600 "Ancho" => 2674 "Tamanyo" => 420479 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Customized hip cement mega-spacer for a hip megaprosthesis septic two-stage revision surgery after osteogenic osteoblastic sarcoma (preoperative, 1st stage, spacer and 2nd stage).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and outcome after infection of megaprostheses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Pilge" 1 => "G. Gradl" 2 => "R. von Eisenhart-Rothe" 3 => "H. Gollwitzer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5301/HIP.2012.9576" "Revista" => array:4 [ "tituloSerie" => "HIP Int" "fecha" => "2012" "volumen" => "22" "numero" => "Suppl. 8" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0090" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fighting megaprosthetic infections: what are the chances of winning?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.K. Gundavda" 1 => "A. Katariya" 2 => "R. Reddy" 3 => "M.G. Agarwal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s43465-020-00080-z" "Revista" => array:6 [ "tituloSerie" => "Indian J Orthop" "fecha" => "2020" "volumen" => "54" "paginaInicial" => "469" "paginaFinal" => "476" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32549962" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0095" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparing the use of preformed vs hand-made antibiotic spacer cement in two stages revision of hip periprosthetic infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Rollo" 1 => "G. Logroscino" 2 => "D. Stomeo" 3 => "R. Cioffi" 4 => "V. Calvisi" 5 => "L. Meccariello" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcot.2020.08.003" "Revista" => array:7 [ "tituloSerie" => "J Clin Orthop Trauma" "fecha" => "2020" "volumen" => "11" "numero" => "Suppl. 5" "paginaInicial" => "S772" "paginaFinal" => "S778" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32999554" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0100" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel molded antibiotic cement spacer: is it better than handmade cement spacer for treatment of chronically infected total hip arthroplasty?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Pinsornsak" 1 => "T. Niruktisarn" 2 => "P. Surabotsopon" 3 => "K. Boontanapibul" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00264-022-05456-4" "Revista" => array:5 [ "tituloSerie" => "Int Orthop" "fecha" => "2022" "volumen" => "46" "paginaInicial" => "1693" "paginaFinal" => "1700" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0105" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The influence of spacer design on the rate of complications in two-stage revision hip arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.W. Jones" 1 => "N. Selemon" 2 => "A. Nocon" 3 => "M. Bostrom" 4 => "G. Westrich" 5 => "P.K. Sculco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arth.2019.02.012" "Revista" => array:6 [ "tituloSerie" => "J Arthroplasty" "fecha" => "2019" "volumen" => "34" "paginaInicial" => "1201" "paginaFinal" => "1206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30879874" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0110" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraoperatively-made cement-on-cement antibiotic-loaded articulating spacer for infected total knee arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Shen" 1 => "X. Zhang" 2 => "Y. Jiang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.knee.2009.11.007" "Revista" => array:6 [ "tituloSerie" => "Knee" "fecha" => "2010" "volumen" => "17" "paginaInicial" => "407" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20202852" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0115" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of augmented antibiotic-loaded cement spacer in periprosthetic joint infection patients with acetabular bone defect" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Fu" 1 => "Y. Xiang" 2 => "M. Ni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13018-020-01831-2" "Revista" => array:3 [ "tituloSerie" => "J Orthop Surg Res" "fecha" => "2020" "volumen" => "15" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0120" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Custom-made, antibiotic-loaded, acrylic cement spacers using a dental silicone template for treatment of infected hip prostheses" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Ohtsuru" 1 => "Y. Morita" 2 => "Y. Murata" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00590-017-2117-3" "Revista" => array:6 [ "tituloSerie" => "Eur J Orthop Surg Traumatol" "fecha" => "2018" "volumen" => "28" "paginaInicial" => "615" "paginaFinal" => "620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29332203" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0125" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Espaciador de cadera «invertido» para defectos masivos de fémur distal en infecciones periprotésicas de rodilla" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "X. Flores" 1 => "M. Vicente" 2 => "S. Haddad" 3 => "C. Amat" 4 => "L. Carrera" 5 => "P.S. Corona" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.recot.2016.06.008" "Revista" => array:7 [ "tituloSerie" => "Rev Esp Cir Ortop Traumatol" "fecha" => "2016" "volumen" => "60" "paginaInicial" => "346" "paginaFinal" => "354" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27546866" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1878875016311111" "estado" => "S300" "issn" => "18788750" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0130" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical complications with one hundred and thirty eight (antibiotic-laden) cement spacers in the treatment of periprosthetic infection after total hip arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Faschingbauer" 1 => "H. Reichel" 2 => "R. Bieger" 3 => "T. Kappe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00264-014-2636-z" "Revista" => array:6 [ "tituloSerie" => "Int Orthop" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "989" "paginaFinal" => "994" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25582658" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0135" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconstruction plate-based antibiotic cement spacers: clinical outcomes and description of technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.V. Maheshwari" 1 => "R. Pivec" 2 => "R. Abraham" 3 => "Q. Naziri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1615/JLongTermEffMedImplants.2017020613" "Revista" => array:6 [ "tituloSerie" => "J Long Term Eff Med Implants" "fecha" => "2018" "volumen" => "28" "paginaInicial" => "37" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29772991" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0140" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of large segmental bone defects at the knee with intramedullary stabilized antibiotic spacers during two-stage treatment of endoprosthetic joint infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.A. Ippolito" 1 => "J.E. Thomson" 2 => "S.M. Rivero" 3 => "K.S. Beebe" 4 => "F.R. Patterson" 5 => "J. Benevenia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arth.2021.01.026" "Revista" => array:6 [ "tituloSerie" => "J Arthroplasty" "fecha" => "2021" "volumen" => "36" "paginaInicial" => "2165" "paginaFinal" => "2170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33546952" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0145" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Creating a dual articulating antibiotic spacer for management of an infected total femur prosthesis hemiarthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.J. Maupin" 1 => "E. Corning" 2 => "R.G. Steinmetz" 3 => "J. White" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.artd.2019.07.002" "Revista" => array:6 [ "tituloSerie" => "Arthroplast Today" "fecha" => "2019" "volumen" => "5" "paginaInicial" => "482" "paginaFinal" => "485" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31886393" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0150" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes after antibiotic megaspacer implantation in patients with severe chronic periprosthetic infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.J. Amin" 1 => "R.M. Patel" 2 => "C.J. Gutowski" 3 => "T.W.B. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jor.24911" "Revista" => array:6 [ "tituloSerie" => "J Orthop Res" "fecha" => "2021" "volumen" => "39" "paginaInicial" => "308" "paginaFinal" => "319" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33179324" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0155" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of the type of bone cement used in two-stage exchange arthroplasty for chronic periarticular joint infection on the spacer replacement and reinfection rate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.-W. Chang" 1 => "C.-T. Wu" 2 => "S.-H. Yen" 3 => "T.L. Tan" 4 => "P.-C. Lin" 5 => "F.-C. Kuo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/jcm12020600" "Revista" => array:5 [ "tituloSerie" => "J Clin Med" "fecha" => "2023" "volumen" => "12" "paginaInicial" => "600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36675529" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0160" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Two-stage revision of total hip arthroplasty for infection is associated with a high rate of dislocation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I.P. McAlister" 1 => "K.I. Perry" 2 => "K.C. Mara" 3 => "A.D. Hanssen" 4 => "D.J. Berry" 5 => "M.P. Abdel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.18.00124" "Revista" => array:5 [ "tituloSerie" => "J Bone Jt Surg Am" "fecha" => "2019" "volumen" => "101" "paginaInicial" => "322" "paginaFinal" => "329" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18884415/unassign/S1888441524000274/v2_202401301224/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18884415/unassign/S1888441524000274/v2_202401301224/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441524000274?idApp=UINPBA00004N" ]
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