髋关节假体周围关节感染的两阶段治疗与较高的感染控制率但高死亡率相关。
Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality.
机构信息
Joint Implant Surgeons, Inc, 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054, USA.
出版信息
Clin Orthop Relat Res. 2013 Feb;471(2):510-8. doi: 10.1007/s11999-012-2595-x.
BACKGROUND
Periprosthetic infection after total hip arthroplasty (THA) is a devastating complication. Reported rates of infection control range from 80% to 95% but mortality rates associated with treatment of infected THA are also substantial and we suspect underreported.
QUESTIONS/PURPOSES: For patients selected for two-stage treatment of infected THA we therefore determined (1) mortality; (2) rate of reimplantation; and (3) rate of reinfection.
METHODS
We identified 202 patients (205 hips) with infected primary or revision THA treated with a two-stage protocol between 1996 and 2009 in our prospectively collected practice registry. Patients underwent two-stage treatment for infection, including removal of all implants and foreign material with implantation of an antibiotic-laden cement spacer in the first stage followed by intravenous culture-specific antibiotics for a minimum of 6 weeks. Second-stage reimplantation was performed if erythrocyte sedimentation rate and C-reactive protein were trending toward normal and the wound was well healed. Thirteen patients (13 hips) were lost to followup before 24 months. The minimum followup in surviving patients was 24 months or failure (average, 53 months; range, 24-180 months).
RESULTS
Fourteen patients (7%; 14 hips) died before reimplantation and two were not candidates because of medical comorbidities. The 90-day mortality rate after the first-stage débridement was 4% (eight patients). Of the 186 patients (189 hips) who underwent reimplantation, 157 (83%) achieved control of the infection. Including all patients who underwent the first stage, survival and infection control after two-stage reimplantation was 76%.
CONCLUSION
Two-stage treatment of deep infection in primary and revision THA is associated with substantial mortality and a substantial failure rate from both reinfection and inability to perform the second stage.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
全髋关节置换术后（THA）发生假体周围感染是一种破坏性的并发症。据报道，感染控制率为 80%至 95%，但与治疗感染性 THA 相关的死亡率也相当高，而且我们怀疑该死亡率被低估了。
问题/目的：因此，对于选择接受两阶段治疗的感染性 THA 患者，我们确定了（1）死亡率；（2）再植入率；以及（3）再感染率。
方法
我们在前瞻性收集的实践登记处中，确定了 1996 年至 2009 年期间接受两阶段方案治疗的 202 例（205 髋）原发性或翻修性 THA 感染患者。患者接受两阶段治疗感染，包括在第一阶段去除所有植入物和异物，并植入抗生素载水泥间隔物，然后静脉注射特定的抗生素至少 6 周。如果红细胞沉降率和 C 反应蛋白趋于正常且伤口愈合良好，则进行第二期再植入。13 例患者（13 髋）在 24 个月前失访。存活患者的最短随访时间为 24 个月或失败（平均 53 个月；范围，24-180 个月）。
结果
在再植入前，有 14 例患者（7%；14 髋）死亡，有 2 例患者因合并症而不适合再植入。第一阶段清创术后 90 天死亡率为 4%（8 例）。在接受再植入的 186 例患者（189 髋）中，157 例（83%）控制了感染。包括接受第一阶段治疗的所有患者，两阶段再植入后，生存率和感染控制率为 76%。
结论
原发性和翻修性 THA 深部感染的两阶段治疗与较高的死亡率和因再感染和无法进行第二期治疗而导致的较高失败率有关。
证据水平
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。
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