Department of Orthopedics, Chang Gung Memorial Hospital at Taoyuan, Taiwan.
Int J Infect Dis. 2010 Dec;14(12):e1054-9. doi: 10.1016/j.ijid.2010.06.018. Epub 2010 Oct 8.
Liver cirrhosis is a well-known co-morbidity in prosthetic hip infection (PHI), but the results of treatment and prognostic factors that predict outcomes of PHI in cirrhotic patients have not been studied.
We performed a cohort study of patients with liver cirrhosis who contracted PHI and were treated at our institution between January 1990 and December 2004.
Of 349 first-time episodes of PHI during the study period, 33 (9.5%) occurred in patients with liver cirrhosis. Debridement with retention of the prosthesis (DWROP) was the initial treatment modality for 24 (73%) episodes of PHI and cured the infection in seven (29%). A shorter median duration of symptoms (5 vs. 14 days; p=0.007) and absence of a sinus tract (p=0.02) were associated with successful treatment. Excision arthroplasty (EA) was required in 26 (79%) episodes and eradicated PHI in 24 (92%). In 20 patients who had reimplantation of a new prosthesis, the infection recurred in six (30%). Patients who developed hepatic decompensation after reimplantation had a significantly higher risk of recurrent PHI than those who did not (relative risk 7.5; 95% confidence interval 4.8-9.5; p=0.018).
Liver cirrhosis is a common co-morbidity in patients with PHI treated at our institution. DWROP should be considered only when there is no sinus tract and the duration of symptoms is very short (less than 10 days). EA is an effective procedure to cure infection. However, reimplantation of hip prosthesis in these patients carries a high risk of infection recurrence, especially in those who develop hepatic decompensation.
肝硬化是人工髋关节感染（PHI）的一种已知合并症，但尚未研究肝硬化患者 PHI 的治疗结果和预测预后的因素。
我们对 1990 年 1 月至 2004 年 12 月在我院接受治疗的患有肝硬化并患有 PHI 的患者进行了队列研究。
在研究期间，349 例首次 PHI 发作中有 33 例（9.5%）发生在肝硬化患者中。保留假体的清创术（DWROP）是 24 例（73%）PHI 初始治疗方式，治愈了 7 例（29%）感染。症状的中位数持续时间更短（5 天 vs. 14 天；p=0.007）且无窦道（p=0.02）与成功治疗相关。需要进行 26 例（79%）切除关节成形术（EA），并根除了 24 例（92%）PHI。在 20 例重新植入新假体的患者中，有 6 例（30%）感染复发。与未发生肝失代偿的患者相比，发生肝失代偿的患者在重新植入后再次发生 PHI 的风险明显更高（相对风险 7.5；95%置信区间 4.8-9.5；p=0.018）。
肝硬化是在我们医院接受 PHI 治疗的患者的常见合并症。只有在没有窦道且症状持续时间非常短（少于 10 天）的情况下，才应考虑 DWROP。EA 是治愈感染的有效方法。但是，在这些患者中重新植入髋关节假体感染复发的风险很高，尤其是在发生肝失代偿的患者中。
