Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Clin Orthop Relat Res. 2011 Dec;469(12):3477-85. doi: 10.1007/s11999-011-2119-0. Epub 2011 Oct 14.
The treatment for an early postoperative periprosthetic infection after cementless THA that results in the highest quality of life after the control of infection is unknown. Although common treatments include irrigation and débridement with component retention, a one-stage exchange, or a two-stage exchange, it is unclear whether any of these provides a higher quality of life after the control of infection.
QUESTIONS/PURPOSES: We projected, through decision-analysis modeling, the possible estimated final health states defined as health-related quality of life based on quality-of-life studies of an early postoperative periprosthetic infection after cementless THA treated by irrigation and débridement, one-stage exchange, or two-stage exchange.
Publications addressing early postoperative infections after THA were analyzed for the estimated rate of infection control and quality-of-life measures after a specific treatment. Decision analysis was used to model the different treatments and describe which, if any, treatment results in the greatest quality of life after early THA infection.
In the model, a one-stage exchange was the treatment for early THA infection that maximized quality-of-life outcomes if the probability of controlling the infection exceeded 66% with this procedure. If the probability of infection control of a one-stage exchange was less than 66% or that of irrigation and débridement was greater than 60%, then irrigation and débridement appeared to result in the greatest quality-of-life outcome.
A decision analysis using estimates of infection control rate and quality-of-life outcomes after different treatments for an early postoperative infection after THA showed possible outcomes for each treatment.
Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
对于非骨水泥型全髋关节置换术后早期假体周围感染的治疗，在控制感染后，哪种方法能获得最佳的生活质量尚不清楚。虽然常见的治疗方法包括保留假体的冲洗和清创术、一期翻修或二期翻修，但尚不清楚这些方法中的任何一种在控制感染后是否能提供更高的生活质量。
问题/目的：我们通过决策分析模型预测，在控制感染后，根据非骨水泥型全髋关节置换术后早期假体周围感染的生活质量研究，冲洗和清创术、一期翻修或二期翻修治疗后，可能的预期最终健康状态（即基于健康相关的生活质量）。
分析了全髋关节置换术后早期感染的相关文献，以确定特定治疗后感染控制率和生活质量评估的估计值。采用决策分析来模拟不同的治疗方法，并描述哪种治疗方法（如果有的话）在早期全髋关节置换术后感染后能获得最大的生活质量。
在模型中，如果一期翻修术控制感染的概率超过 66%，则该方法是治疗早期全髋关节置换术后感染的首选方法，可获得最佳的生活质量结果。如果一期翻修术控制感染的概率低于 66%或冲洗和清创术控制感染的概率高于 60%，则冲洗和清创术似乎会产生最佳的生活质量结果。
使用不同治疗方法控制感染率和全髋关节置换术后早期感染后生活质量评估的估计值进行决策分析，可显示出每种治疗方法的可能结果。
二级，经济和决策分析。欲了解完整的证据等级描述，请参见作者指南。
