Department of Orthopaedics, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2019 Apr;23(2 Suppl):65-75. doi: 10.26355/eurrev_201904_17476.
Periprosthetic joint infections (PJI) are one of the most dangerous complications in hip surgery. "Two-stage" revision surgery is the treatment of choice. Nevertheless, 5-10% of failures are reported. The aim of this study is to evaluate which factors determine the failure of the two-stage revision in patients affected by hip PJI.
We retrospectively enrolled 21 patients treated for hip PJI who had undergone two-stage revision surgery. The diagnosis had been made using criteria established by the Musculoskeletal Infection Society (MSIS) and readapted by the Philadelphia Consensus Conference group. The patients underwent periodic clinical and laboratory controls after the surgical procedure. The two-stage revision treatment was considered unsuccessful in the event of re-infection or in case of severe complications occurring within one year from the treatment.
At a mean follow-up of 23.8 months 57% healed with no complications. The reinfection rate was 19% and, after the 3rd stage, the final failure rate was 9.5%. The study has shown, with statistical significance, that a greater number of previous surgical procedures (p<0.05, OR=22) and BMI>25 (p<0.05, OR=4) represent increased risk factors in predicting the failure of two-stage revision surgery. Age, CRP, ESR and a shorter lapse (<60 days) between 1st and 2nd stage were recorded in the failure cases, and have to be considered, even if not statistically significant.
Knowing the factors responsible for the increased failure of two-stage revision could lead to closer monitoring and more aggressive management in those patients expected to be at greater risk of reinfection. Obesity and multiple surgeries are risk factors for failure.
人工关节周围感染（PJI）是髋关节手术中最危险的并发症之一。“二期”翻修手术是首选治疗方法。然而，仍有 5-10%的病例报告失败。本研究旨在评估哪些因素决定了髋关节 PJI 患者二期翻修的失败。
我们回顾性纳入了 21 例接受髋关节 PJI 二期翻修手术的患者。该诊断采用了由肌肉骨骼感染学会（MSIS）制定并经费城共识会议组改编的标准。术后患者定期进行临床和实验室检查。如果在治疗后一年内发生再感染或出现严重并发症，则认为二期翻修治疗失败。
在平均 23.8 个月的随访中，57%的患者治愈且无并发症。再感染率为 19%，在第 3 期后，最终失败率为 9.5%。研究表明，手术次数较多（p<0.05，OR=22）和 BMI>25（p<0.05，OR=4）具有统计学意义，是预测二期翻修手术失败的危险因素。在失败病例中记录到年龄、CRP、ESR 和第 1 期和第 2 期之间的较短间隔（<60 天），尽管这些因素没有统计学意义，但也需要考虑。
了解导致二期翻修失败风险增加的因素，可以使那些预期有更高再感染风险的患者得到更密切的监测和更积极的管理。肥胖和多次手术是失败的危险因素。
