Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
Clin Orthop Relat Res. 2013 Oct;471(10):3214-22. doi: 10.1007/s11999-013-3079-3.
Acute postoperative infection after total hip arthroplasty (THA) is typically treated with irrigation and débridement and exchange of the modular femoral head and acetabular liner. Given a rate of failure exceeding 50% in some series, a one-stage exchange has been suggested as a potential alternative because it allows more thorough débridement and removal of colonized implants. To date, most studies published on the one-stage exchange have used microbe-specific antibiotic-laden bone cement with only one small single-institution series that reported outcomes after a cementless one-stage exchange.
QUESTIONS/PURPOSES: We determined whether a one-stage cementless exchange for treating acute postoperative infection after THA would result in infection control with component retention and normalization of infection markers.
We retrospectively identified 27 patients who underwent a one-stage exchange performed for an acute (≤6 weeks) postoperative infection after THA from April 2004 to December 2009. Primary cementless components were used both at the time of the index arthroplasty and the revision in all patients. Surgery was followed by a 6-week course of culture-specific antibiotics in all patients and a variable course of oral antibiotics. Our primary outcome was retention of the implants at most recent followup and our secondary outcome was normalization of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) at most recent followup. Patients were followed until failure or a minimum of 2 years.
At a minimum followup of 27 months (mean, 50 months; range, 27-89 months), 19 of the 27 patients (70%) retained their implants but four required further operative débridement with component retention at a mean of 3 weeks (range, 2-6 weeks) to obtain control of infection. Thus, an isolated single-stage exchange was successful in 15 of the 27 patients (56%). Eight patients (30%) ultimately had a two-stage exchange for persistent infection; seven of these patients required no further surgery, whereas one patient required a second two-stage exchange. Of those patients retaining their prosthesis after one-stage exchange and tracked with ESR and CRP, four (33% [four of 12]) had elevated values without other signs or symptoms of recurrent infection.
For acute postoperative infection after primary THA, a one-stage cementless exchange allowed 70% of patients to retain their implants at most recent followup. Of those patients who ultimately went on to a two-stage exchange, only one required a second two-stage exchange.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
全髋关节置换术（THA）后急性术后感染通常采用灌洗清创术和模块化股骨头及髋臼衬垫的更换来治疗。由于某些系列的失败率超过 50%，因此建议采用一期置换作为一种潜在的替代方法，因为它可以更彻底地清创和去除定植的植入物。迄今为止，大多数关于一期置换的研究都使用了针对特定微生物的抗生素载骨水泥，只有一个小型单机构系列报告了非骨水泥一期置换后的结果。
问题/目的：我们确定在 THA 后急性（≤6 周）术后感染的情况下，进行一期非骨水泥置换是否会通过保留假体和使感染标志物正常化来控制感染。
我们回顾性地确定了 2004 年 4 月至 2009 年 12 月期间因 THA 后急性（≤6 周）术后感染而行一期置换的 27 例患者。所有患者在初次关节置换和翻修时均使用了原发性非骨水泥假体。所有患者术后均接受 6 周的针对特定病原体的抗生素治疗，并根据情况口服抗生素。我们的主要结果是在最近的随访中保留假体，次要结果是在最近的随访中红细胞沉降率（ESR）和 C 反应蛋白（CRP）正常化。患者随访至失败或至少 2 年。
在至少 27 个月（平均 50 个月；范围，27-89 个月）的随访中，27 例患者中有 19 例（70%）保留了假体，但有 4 例需要在 3 周（范围，2-6 周）内进行进一步的清创术，以保留假体并控制感染。因此，27 例患者中有 15 例（56%）孤立的一期置换获得成功。8 例（30%）患者因持续感染最终行二期置换；其中 7 例患者无需进一步手术，1 例患者需要进行第二次二期置换。在进行一期置换并进行 ESR 和 CRP 随访的保留假体的患者中，有 4 例（33%[12 例中的 4 例]）的 ESR 和 CRP 值升高，但无其他复发性感染的迹象或症状。
对于初次 THA 后急性术后感染，一期非骨水泥置换可使 70%的患者在最近的随访中保留假体。在最终需要进行二期置换的患者中，只有 1 例需要进行第二次二期置换。
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。
