Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada.
Clin Orthop Relat Res. 2011 Apr;469(4):1009-15. doi: 10.1007/s11999-010-1725-6.
Methicillin-resistant hip infections are increasingly common. Reports of the surgical management of these patients using two-stage THA show variable control of infection, but all reports used static spacers.
QUESTIONS/PURPOSES: We therefore determined (1) the rate of successful control of infection and (2) function in patients with methicillin-resistant infection treated with a two-stage THA using an articulated cement spacer during the first stage.
We retrospectively reviewed 50 patients who had a two-stage revision THA for methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis infection. Twelve patients died, leaving 38 for review. All eligible patients completed quality-of-life outcome questionnaires (WOMAC, SF-12, Oxford-12, UCLA activity score, hip and knee satisfaction score). Minimum followup was 24 months after the second stage (mean, 58 months; range, 24-123 months).
Of the 38 patients, eight (21%) had recurrence of their infection requiring further revision surgery. Of the remaining 27 patients, the mean WOMAC was 62, mean Oxford-12 60, mean UCLA activity score 4.3, and mean hip and knee satisfaction score 66.
We found a treatment failure rate of 21% for patients with methicillin-resistant S. aureus or methicillin-resistant S. epidermidis infection. This is a higher rate than reported for two-stage THA for studies including patients infected with both nonresistant and resistant organisms. The functional scores for patients were also lower than those reported in the literature.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
耐甲氧西林的髋关节感染越来越常见。使用两阶段全髋关节置换术（THA）治疗这些患者的手术管理报告显示出感染控制的变化，但所有报告均使用静态间隔物。
问题/目的：因此，我们确定了（1）使用关节水泥间隔物在第一阶段治疗耐甲氧西林金黄色葡萄球菌或耐甲氧西林表皮葡萄球菌感染的两阶段 THA 患者中感染控制成功率，以及（2）功能。
我们回顾性分析了 50 例因耐甲氧西林金黄色葡萄球菌或耐甲氧西林表皮葡萄球菌感染而行两阶段翻修 THA 的患者。12 例患者死亡，留下 38 例进行回顾。所有符合条件的患者均完成了生活质量问卷调查（WOMAC、SF-12、牛津 12、UCLA 活动评分、髋关节和膝关节满意度评分）。第二次手术后的最低随访时间为 24 个月（平均 58 个月；范围 24-123 个月）。
在 38 例患者中，有 8 例（21%）出现感染复发，需要进一步翻修手术。在其余 27 例患者中，WOMAC 平均为 62 分，牛津 12 平均为 60 分，UCLA 活动评分平均为 4.3 分，髋关节和膝关节满意度评分平均为 66 分。
我们发现耐甲氧西林金黄色葡萄球菌或耐甲氧西林表皮葡萄球菌感染患者的治疗失败率为 21%。这一比率高于包括非耐药和耐药菌感染患者的两阶段 THA 研究报告的比率。患者的功能评分也低于文献报道的水平。
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
