Zajonz Dirk, Wuthe Lena, Tiepolt Solveig, Brandmeier Philipp, Prietzel Torsten, von Salis-Soglio Georg Freiherr, Roth Andreas, Josten Christoph, Heyde Christoph-E, Ghanem Mohamed
Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
Department of Nuclear medicine, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
Patient Saf Surg. 2015 May 16;9:20. doi: 10.1186/s13037-015-0071-8. eCollection 2015.
Elective knee and hip arthroplasty is followed by infections in currently about 0.5-2.0 % of cases - a figure which is on the increase due to the rise in primary implants. Correct diagnosis early on is essential so that appropriate therapy can be administered. This work presents a retrospective analysis of the diagnoses of patients suffering infections after total hip or knee arthroplasty.
320 patients with prosthetic joint infection (PJI) following knee or hip arthroplasty were identified. They comprised a) 172 patients with an infection after total hip arthroplasty (THA): 56 % females (n = 96) and 44 % males (n = 76) with a mean age of 70.9 (39-92) years; and 148 patients with an infection after total knee arthroplasty (TKA): 55 % females (n = 82) and 45 % males (n = 66) with a mean age of 70.7 (15-87) years.
Although significantly more TKA than THA patients reported pain, erythema, a burning sensation and swelling, no differences between the two groups were observed with respect to dysfunction, fever or fatigue. However, significant differences were noted in the diagnosis of loosening (THA 55 %, TKA 31 %, p < 0.001) and suspected infection using conventional X-rays (THA 61 %, TKA 29 %, p < 0.001). FDG-PET-CT produced very good results in nearly 95 % of cases. There were no differences between THA and TKA patients regarding levels of inflammation markers. Histological evaluation proved to be significantly better than microbiological analysis.
The clinical picture may be non-specific and not show typical inflammatory symptoms for a long time, particularly in PJI of the hip. As imaging only provides reliable conclusions after the symptoms have persisted for a long time, morphological imaging is not suitable for the detection of early infections. FDG-PT-CT proved to be the most successful technique and is likely to be used more frequently in future. Nevertheless, there are currently no laboratory parameters which are suitable for the reliable primary diagnosis of PJI. Diagnosis requires arthrocentesis, and the fluid obtained should always be examined both microbiologically and histologically.
目前，选择性膝关节和髋关节置换术后感染率约为0.5%-2.0%，随着初次植入手术数量的增加，这一数字还在上升。早期正确诊断至关重要，以便能够进行适当的治疗。本文对全髋关节或膝关节置换术后感染患者的诊断进行了回顾性分析。
确定了320例膝关节或髋关节置换术后假体关节感染（PJI）患者。其中包括：a）172例全髋关节置换术（THA）后感染患者：女性56%（n = 96），男性44%（n = 76），平均年龄70.9岁（39-92岁）；以及148例全膝关节置换术（TKA）后感染患者：女性55%（n = 82），男性45%（n = 66），平均年龄70.7岁（15-87岁）。
尽管报告疼痛、红斑、烧灼感和肿胀的TKA患者明显多于THA患者，但两组在功能障碍、发热或疲劳方面未观察到差异。然而，在松动诊断方面（THA为55%，TKA为31%，p < 0.001）以及使用传统X线诊断疑似感染方面（THA为61%，TKA为29%，p < 0.001）存在显著差异。FDG-PET-CT在近95%的病例中产生了非常好的结果。THA和TKA患者在炎症标志物水平方面没有差异。组织学评估结果明显优于微生物学分析。
临床表现可能不具有特异性，且长时间内不表现出典型的炎症症状，尤其是在髋关节PJI中。由于成像仅在症状持续很长时间后才能提供可靠结论，因此形态学成像不适用于早期感染的检测。FDG-PT-CT被证明是最成功的技术，未来可能会更频繁地使用。然而，目前尚无适用于PJI可靠初步诊断的实验室参数。诊断需要进行关节穿刺，所获取的液体应始终进行微生物学和组织学检查。
