Akgün D, Müller M, Perka C, Winkler T
Charite - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery, Charitéplatz 1, D-10117 Berlin, Germany.
Bone Joint J. 2017 Nov;99-B(11):1490-1495. doi: 10.1302/0301-620X.99B11.BJJ-2017-0243-R1.
The aim of this study was to identify the incidence of positive cultures during the second stage of a two-stage revision arthroplasty and to analyse the association between positive cultures and an infection-free outcome.
This single-centre retrospective review of prospectively collected data included patients with a periprosthetic joint infection (PJI) of either the hip or the knee between 2013 and 2015, who were treated using a standardised diagnostic and therapeutic algorithm with two-stage exchange. Failure of treatment was assessed according to a definition determined by a Delphi-based consensus. Logistic regression analysis was performed to assess the predictors of positive culture and risk factors for failure. The mean follow-up was 33 months (24 to 48).
A total of 163 two-stage revision arthroplasties involving 84 total hip arthroplasties (THAs) and 79 total knee arthroplasties (TKAs) were reviewed. In 27 patients (16.6%), ≥ 1 positive culture was identified at re-implantation and eight (29.6%) of these subsequently failed compared with 20 (14.7%) patients who were culture-negative. The same initially infecting organism was isolated at re-implantation in nine of 27 patients (33.3%). The organism causing re-infection in none of the patients was the same as that isolated at re-implantation. The risk of the failure of treatment was significantly higher in patients with a positive culture (odds ratio (OR) 1.7; 95% confidence interval (CI) 1.0 to 3.0; p = 0.049) and in patients with a higher Charlson Comorbidity Index (OR 1.5; 95% CI 1.6 to 1.8; p = 0.001).
Positive culture at re-implantation was independently associated with subsequent failure. Surgeons need to be aware of this association and should consider the medical optimisation of patients with severe comorbidities both before and during treatment. Cite this article: 2017;99-B:1490-5.
本研究旨在确定两阶段翻修关节成形术第二阶段中培养阳性的发生率，并分析培养阳性与无感染结局之间的关联。
这项对前瞻性收集数据的单中心回顾性研究纳入了2013年至2015年间接受标准化诊断和治疗算法的两阶段置换治疗的髋或膝关节假体周围感染（PJI）患者。根据基于德尔菲共识确定的定义评估治疗失败情况。进行逻辑回归分析以评估培养阳性的预测因素和失败的危险因素。平均随访时间为33个月（24至48个月）。
共回顾了163例两阶段翻修关节成形术，其中包括84例全髋关节置换术（THA）和79例全膝关节置换术（TKA）。27例患者（16.6%）在再次植入时培养结果为≥1次阳性，其中8例（29.6%）随后治疗失败，而培养结果为阴性的患者有20例（14.7%）。27例患者中有9例（33.3%）在再次植入时分离出与最初感染相同的病原体。在任何患者中，引起再次感染的病原体与再次植入时分离出的病原体均不相同。培养阳性的患者（比值比（OR）1.7；95%置信区间（CI）1.0至3.0；p = 0.049）以及Charlson合并症指数较高的患者（OR 1.5；95% CI 1.6至1.8；p = 0.001）治疗失败的风险显著更高。
再次植入时培养阳性与随后的治疗失败独立相关。外科医生需要了解这种关联，并应在治疗前和治疗期间考虑对患有严重合并症的患者进行医疗优化。引用本文：2017；99-B：1490-5。
