Department of Orthopaedics, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan.
Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopedics, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2017 Dec;33(12):623-629. doi: 10.1016/j.kjms.2017.08.005. Epub 2017 Sep 3.
Reinfection after two-stage revision hip arthroplasty (RHA) is still a complex issue. Only few studies revealed the factors affecting the success rate in the treatment of periprosthetic hip infection (PHI), especially risk factors. A retrospective study was conducted using records of 30 patients underwent two-stage RHA for infected total hip arthroplasty (THA). Treatment was defined as successful if a patient did not need any reoperation or invasive procedure such as image-guided drainage during the two years after reimplantation. Treatment was defined as failure if any surgery or invasive procedure or long-term antibiotic suppression was considered necessary to control infection. Four patients had infection recurrence defined as failed and three of them had intravenous drug abuse. Twenty-six patients had no infection recurrence at the end of follow-up and one of them had intravenous drug abuse but quitting after surgery. We suggest that once adequate cleaning up achieved, risk of reinfection may be little even in immunocompromised patients with RHA because of relative less old age than those with revisional total knee arthroplasty. Patients of the reinfection group were younger and non-obese with adequate nutritional status. We may consider intravenous drug abuse could take a great toll on health and lead to reinfection. Finally, we suggest performing the gold-standard two-stage reimplantation technique to manage cases with infection, educating drug abusers regarding the risk of surgical failure, and implementing a quitting program at least 1 year before the index surgery.
二期翻修髋关节置换术后再感染（RHA）仍然是一个复杂的问题。只有少数研究揭示了影响治疗人工关节周围感染（PHI）成功率的因素，尤其是危险因素。本研究回顾性分析了 30 例接受二期 RHA 治疗感染性全髋关节置换术（THA）患者的记录。如果患者在再植入后的两年内不需要任何再次手术或侵入性操作（如影像学引导下引流），则定义为治疗成功。如果需要任何手术或侵入性操作或长期抗生素抑制来控制感染，则定义为治疗失败。4 例患者感染复发定义为失败，其中 3 例有静脉药物滥用史。26 例患者在随访结束时无感染复发，其中 1 例有静脉药物滥用史，但术后已戒除。我们认为，一旦达到充分的清创，即使在免疫功能低下的 RHA 患者中，由于相对较年轻且比接受翻修全膝关节置换术的患者年龄较小，再次感染的风险可能较小。再感染组的患者年龄较小，非肥胖且营养状况良好。我们可能认为静脉药物滥用会对健康造成很大的损害，并导致再次感染。最后，我们建议对感染患者采用金标准的两期再植入技术，对药物滥用者进行手术失败风险的教育，并在指数手术前至少 1 年实施戒除计划。
