人工关节周围感染两阶段翻修术中短间隔与长间隔的结局：一项前瞻性队列研究。

Outcome of short versus long interval in two-stage exchange for periprosthetic joint infection: a prospective cohort study.

作者信息

Winkler Tobias, Stuhlert Malte G W, Lieb Elke, Müller Michael, von Roth Philipp, Preininger Bernd, Trampuz Andrej, Perka Carsten F

机构信息

Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.

Julius Wolff Institute, Berlin, Germany.

出版信息

Arch Orthop Trauma Surg. 2019 Mar;139(3):295-303. doi: 10.1007/s00402-018-3052-4. Epub 2018 Nov 15.

DOI:10.1007/s00402-018-3052-4

PMID:30443674

Abstract

INTRODUCTION

A two-stage exchange is the standard treatment approach for chronic periprosthetic joint infection (PJI). While a 6-8 week interval is commonly used before reimplantation, the optimal length of the prosthesis-free interval has not yet been determined. We evaluated the influence of a short (< 4 weeks) and long (≥ 4 weeks) interval on reinfection rate and functional outcome of hip and knee PJI.

METHODS

In this prospective cohort, patients undergoing two-stage revision for PJI were assigned to prosthesis reimplantation after a short (< 4 weeks) or long (≥ 4 weeks) interval. All patients received standardized antimicrobial therapy, which consisted of antibiogram-adapted, non-biofilm-active antibiotics during the interval and an antimicrobial combination therapy with biofilm-active antibiotics after reimplantation. Follow-up was performed for infection, joint function, pain, need for care and quality of life.

RESULTS

Thirty-eight patients undergoing two-stage revision for PJI (18 hips and 20 knees) were included. Short interval was used in 19 patients having a mean interval of 17.9 days (range 7-27 days), long interval in 19 patients having a mean interval of 63.0 days (range 28-204 days). At a mean follow-up of 39.5 months (range 32-48 months), 37 of 38 patients (97.4%) were infection-free. One failure occurred among patients with long interval and none among patients with short interval. Functional results (ROM, HHS, KSS, VAS) and quality of life (SF-36) were similar in both groups. Patients treated with long interval required cumulatively additional 204 inpatient days for nursing care compared to patients with short interval.

CONCLUSIONS

This study suggests that two-stage exchange with short interval has a similar outcome than with long interval, when highly active antibiotic therapy is used. Patient inconvenience and care costs due to immobilization were lower when strategies with a short interval were used.

摘要

引言

两阶段翻修术是慢性人工关节周围感染（PJI）的标准治疗方法。虽然通常在再次植入前采用6 - 8周的间隔时间，但无假体间隔的最佳时长尚未确定。我们评估了短（<4周）和长（≥4周）间隔时间对髋和膝PJI再感染率及功能结局的影响。

方法

在这项前瞻性队列研究中，接受PJI两阶段翻修术的患者被分配在短（<4周）或长（≥4周）间隔时间后进行假体再植入。所有患者均接受标准化抗菌治疗，包括在间隔期使用根据药敏试验调整的、非生物膜活性抗生素，以及在再植入后使用生物膜活性抗生素的抗菌联合治疗。对感染、关节功能、疼痛、护理需求和生活质量进行随访。

结果

纳入38例接受PJI两阶段翻修术的患者（18例髋关节和20例膝关节）。19例患者采用短间隔，平均间隔时间为17.9天（范围7 - 27天）；19例患者采用长间隔，平均间隔时间为63.0天（范围28 - 204天）。平均随访39.5个月（范围32 - 48个月）时，38例患者中有37例（97.4%）无感染。长间隔组有1例失败，短间隔组无失败病例。两组的功能结果（ROM、HHS、KSS、VAS）和生活质量（SF - 36）相似。与短间隔组患者相比，长间隔组患者累计需要额外204个住院护理日。