Bryan Andrew J, Abdel Matthew P, Sanders Thomas L, Fitzgerald Steven F, Hanssen Arlen D, Berry Daniel J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Bone Joint Surg Am. 2017 Dec 6;99(23):2011-2018. doi: 10.2106/JBJS.16.01103.
There are conflicting data on the results of irrigation and debridement with component retention in patients with acute periprosthetic hip infections. The goals of this study were to examine contemporary results of irrigation and debridement with component retention for acute infection after primary hip arthroplasty and to identify host, organism, antibiotic, or implant factors that predict success or failure.
Ninety hips (57 total hip arthroplasties and 33 hemiarthroplasties) were diagnosed with acute periprosthetic hip infection (using strict criteria) and were treated with irrigation and debridement and component retention between 2000 and 2012. The mean follow-up was 6 years. Patients were stratified on the basis of McPherson criteria. Hips were managed with irrigation and debridement and retention of well-fixed implants with modular head and liner exchange (70%) or irrigation and debridement alone (30%). Seventy-seven percent of patients were treated with chronic antibiotic suppression. Failure was defined as failure to eradicate infection, characterized by a wound fistula, drainage, intolerable pain, or infection recurrence caused by the same organism strain; subsequent removal of any component for infection; unplanned second wound debridement for ongoing deep infection; and/or occurrence of periprosthetic joint infection-related mortality.
Treatment failure occurred in 17% (15 of 90 hips), with component removal secondary to recurrent infection in 10% (9 of 90 hips). Treatment failure occurred in 15% (10 of 66 hips) after early postoperative infection and 21% (5 of 24 hips) after acute hematogenous infection (p = 0.7). Patients with McPherson host grade A had a treatment failure rate of 8%, compared with 16% (p = 0.04) in host grade B and 44% in host grade C (p = 0.006). Most treatment failures (12 of 15 failures) occurred within the initial 6 weeks of treatment; failures subsequent to 6 weeks occurred in 3% of those treated with chronic antibiotic suppression compared with 11% of those who were not treated with suppression (hazard ratio, 4.0; p = 0.3).
The success rate was higher in this contemporary series than in many previous series. Systemic host grade A was predictive of treatment success.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
关于急性人工髋关节感染患者保留假体进行冲洗清创的结果，存在相互矛盾的数据。本研究的目的是探讨初次髋关节置换术后急性感染保留假体进行冲洗清创的当代结果，并确定预测成功或失败的宿主、微生物、抗生素或植入物因素。
90例髋关节（57例全髋关节置换术和33例半髋关节置换术）被诊断为急性人工髋关节感染（采用严格标准），并在2000年至2012年间接受了冲洗清创和保留假体治疗。平均随访6年。患者根据麦克弗森标准进行分层。髋关节采用冲洗清创并保留固定良好的假体，同时更换模块化股骨头和内衬（70%）或仅进行冲洗清创（30%）。77%的患者接受了慢性抗生素抑制治疗。失败定义为未能根除感染，表现为伤口瘘管、引流、无法忍受的疼痛或由同一菌株引起的感染复发；随后因感染取出任何假体组件；因持续深部感染进行计划外的第二次伤口清创；和/或发生与人工关节感染相关的死亡。
17%（90例中的15例）出现治疗失败，其中10%（90例中的9例）因反复感染而取出假体组件。术后早期感染后15%（66例中的10例）出现治疗失败，急性血源性感染后21%（24例中的5例）出现治疗失败（p = 0.7）。麦克弗森宿主分级为A级的患者治疗失败率为8%，B级为16%（p = 0.04），C级为44%（p = 0.006）。大多数治疗失败（15例中的12例）发生在治疗的最初6周内；6周后，接受慢性抗生素抑制治疗的患者中有3%出现失败，未接受抑制治疗的患者中有11%出现失败（风险比，4.0；p = 0.3）。
在这个当代系列中成功率高于许多先前的系列。全身宿主分级为A级可预测治疗成功。
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
