Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia.
J Arthroplasty. 2017 Aug;32(8):2519-2522. doi: 10.1016/j.arth.2017.03.018. Epub 2017 Mar 30.
Two-stage exchange arthroplasty remains the preferred approach to treatment of chronic periprosthetic joint infection (PJI) following total hip arthroplasty (THA). The objective of the present study is to investigate the fate of antibiotic spacers placed for periprosthetic joint infection after THA and evaluate risk factors for outcomes other than reimplantation.
A national database was queried for Medicare patients who underwent removal of an infected hip prosthesis and placement of an antibiotic spacer. Patients with a study end point within 1 year postoperatively were included: (1) in-hospital mortality, (2) repeat debridement without reimplantation within 1 year, (3) resection arthroplasty, and (4) reimplantation of a hip arthroplasty. Independent patient-related risk factors for these end points were evaluated with a multivariate logistic regression analysis.
A total of 7146 patients met all inclusion and exclusion criteria. Within 1 year postoperatively, 464 patients (6.5%) died in a hospital setting, 775 patients (10.8%) had a repeat debridement procedure, 404 patients (5.7%) had a resection arthroplasty, 1202 patients (16.8%) retained their spacers, and the remaining 4301 patients (60.2%) were reimplanted at an average of 124.4 ± 39.3 days. Numerous independent patient-related risk factors for these were identified.
At 1 year only 60% of patients undergo reimplantation. One-sixth of patients retain their spacer and approximately 10% require repeat debridement. Death occurred in at least 6% of the population. Several independent patient-related risk factors exist for repeat debridement, no reimplantation or death within 1 year following index THA removal.
对于全髋关节置换术（THA）后慢性假体周围关节感染（PJI），两阶段置换术仍然是首选治疗方法。本研究的目的是调查 THA 后用于假体周围关节感染的抗生素 spacer 的命运，并评估除再植入以外的结局的风险因素。
对接受感染性髋关节假体取出和抗生素 spacer 植入的 Medicare 患者进行了全国性数据库查询。将术后 1 年内出现研究终点的患者纳入研究：（1）院内死亡，（2）1 年内无再植入的重复清创术，（3）关节切除成形术，（4）髋关节再植入。使用多变量逻辑回归分析评估了这些结局的独立患者相关风险因素。
共有 7146 例患者符合所有纳入和排除标准。术后 1 年内，464 例（6.5%）患者在医院死亡，775 例（10.8%）患者行重复清创术，404 例（5.7%）患者行关节切除成形术，1202 例（16.8%）患者保留了 spacer，其余 4301 例（60.2%）患者在平均 124.4 ± 39.3 天后进行了再植入。确定了许多与这些结果相关的独立患者相关风险因素。
在 1 年内，只有 60%的患者接受了再植入。六分之一的患者保留了 spacer，约 10%的患者需要重复清创术。至少有 6%的患者死亡。在 THA 取出后的 1 年内，存在几个与重复清创术、无再植入或死亡相关的独立患者相关风险因素。
