Haddad Bassem I, Alajlouni Jihad, Hamdan Mohammad, Hawa Ala', Mahmoud Elsiddig E
Faculty of Medicine, Special Surgery Department, Orthopaedics and Trauma Department, University of Jordan, Queen Rania Street, Amman, 11942, Jordan.
Faculty of Medicine and Health Sciences, Omdurman Islamic University, P. O. Box 382, Omdurman, Sudan.
Ann Med Surg (Lond). 2019 Jul 11;45:27-32. doi: 10.1016/j.amsu.2019.07.013. eCollection 2019 Sep.
Arthroplasty has always been associated with complications, such as the possibility of periprosthetic infection. The presence of an active infection at the site of the planned surgery is considered a contraindication for the new implant. However, it is unclear whether there is an association between the presence of remote musculoskeletal infection and the development of infection in the prosthetic joint itself. We report six cases involving patients with active ongoing musculoskeletal infections at a remote site who underwent arthroplasty.
Four male and two female patients were included in this review. Three patients underwent total hip arthroplasty, one underwent hip hemiarthroplasty, and two underwent total knee arthroplasty. All surgeries were performed in the presence of different stages of infection at a remote site; two had active infections with pus-discharging sinus, one was being treated with long-term oral antibiotic suppression, and three patients were diagnosed with remote prosthetic joint infections on the basis of joint aspiration or intraoperative cultures. Clinical assessments of pain, wound erythema or drainage, and soft tissue swelling were performed at follow-up. Radiography and analysis of inflammatory marker levels were performed preoperatively and 6 weeks postoperatively.
All six patients were followed-up for at least 18 months (mean, 4.6 years; range, 18 months to 9 years). No evidence of superficial surgical-site infection or deep prosthetic joint infection was observed.
The presence of an active infection at a remote site might not be a contributing factor to periprosthetic joint infection.
关节置换术一直与并发症相关，比如假体周围感染的可能性。计划手术部位存在活动性感染被视为新植入物的禁忌证。然而，目前尚不清楚远处肌肉骨骼感染的存在与假体关节本身感染的发生之间是否存在关联。我们报告了6例在远处存在活动性肌肉骨骼感染的患者接受关节置换术的病例。
本综述纳入了4例男性和2例女性患者。3例行全髋关节置换术，1例行半髋关节置换术，2例行全膝关节置换术。所有手术均在远处存在不同阶段感染的情况下进行；2例有伴有排脓窦道的活动性感染，1例正在接受长期口服抗生素抑制治疗，3例根据关节穿刺或术中培养被诊断为远处假体关节感染。随访时对疼痛、伤口红斑或引流情况以及软组织肿胀进行了临床评估。术前及术后6周进行了影像学检查和炎症标志物水平分析。
所有6例患者均随访至少18个月（平均4.6年；范围18个月至9年）。未观察到浅表手术部位感染或深部假体关节感染的证据。
远处存在活动性感染可能不是假体周围关节感染的促成因素。
