Clauss Martin, Hunkeler Christof, Manzoni Isabella, Sendi Parham
Interdisciplinary Septic Surgical Unit, Clinic for Orthopedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland.
Center for Muscular-Skeletal Infections, Department of Orthopedics and Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland.
J Bone Jt Infect. 2020 Feb 10;5(1):35-42. doi: 10.7150/jbji.40924. eCollection 2020.
: Debridement, antibiotics and implant retention (DAIR) is a valuable option for treating early and acute periprosthetic joint infection (PJI). The inflammation caused by the infection and the surgical intervention during DAIR may influence the long-term stability of the implant. In this study, we analyzed the sequelae of DAIR on implant survival in hip PJI after cure of infection. : Total hip arthroplasties (THAs) from our database implanted between 1992 and 2016 were included in a retrospective double-cohort study. THAs were exposed (DAIR cohort) or not exposed to DAIR (control cohort). The control cohort comprised patients matched 3:1 to the DAIR cohort. The outcome was implant failure over time. It was evaluated for (i) revision for any reason, (ii) aseptic loosening of any component, and (iii) radiographic evidence of loosening. : 57 THAs (56 patients) were included in the DAIR cohort and 170 THAs (168 patients) in the control cohort. The mean follow-up periods in the DAIR and control cohorts were 6.1 and 7.8 years, respectively. During follow-up, 20 (36%) patients in the DAIR cohort and 54 (32%) in the control cohort died after a mean of 4.1 and 7.2 years, respectively. Revision for any reason was performed in 9 (16%) THAs in the DAIR cohort and in 10 (6%) THAs (p=0.03) in the control cohort, and revision for aseptic loosening of any component in 5 (9%) and 8 (5%) THAs (p=0.32), respectively. Radiological analysis included 56 THAs in the DAIR cohort and 168 THAs in the control cohort. Two (4%) stems and 2 (4%) cups in the DAIR cohort and 7 (4%) and 1 (0.6%) in the control cohort, respectively, demonstrated radiological signs of failure (p=1). : THAs exposed to DAIR were revised for any reason more frequently than were THAs in the control cohort. The difference was mainly caused by septic failures. After cure of PJI, the difference in revisions for aseptic loosening was not significant. There was no significant difference in radiographic evidence of loosening of any component between cohorts. These data suggest that cured hip PJI previously exposed to DAIR do not fail more frequently for aseptic reasons than do THAs not exposed to DAIR.
清创、抗生素及植入物保留（DAIR）是治疗早期急性人工关节周围感染（PJI）的一种有效方法。感染引发的炎症以及DAIR过程中的手术干预可能会影响植入物的长期稳定性。在本研究中，我们分析了DAIR对髋关节PJI感染治愈后植入物存活的后遗症。
我们对1992年至2016年间在数据库中植入的全髋关节置换术（THA）进行了一项回顾性双队列研究。THA接受了DAIR治疗（DAIR队列）或未接受DAIR治疗（对照队列）。对照队列由与DAIR队列按3:1匹配的患者组成。结果是植入物随时间的失败情况。评估内容包括：（i）因任何原因进行翻修；（ii）任何部件的无菌性松动；（iii）松动的影像学证据。
DAIR队列纳入了57例THA（56例患者），对照队列纳入了170例THA（168例患者）。DAIR队列和对照队列的平均随访期分别为6.1年和7.8年。随访期间，DAIR队列中的20例（36%）患者和对照队列中的54例（32%）患者分别在平均4.1年和7.2年后死亡。DAIR队列中有9例（16%）THA因任何原因进行了翻修，对照队列中有10例（6%）THA进行了翻修（p = 0.03），因任何部件无菌性松动进行翻修的分别为5例（9%）和8例（5%）（p = 0.32）。影像学分析包括DAIR队列中的56例THA和对照队列中的168例THA。DAIR队列中有2例（4%）股骨柄和2例（4%）髋臼杯，对照队列中有7例（4%）股骨柄和1例（0.6%）髋臼杯出现了影像学失败迹象（p = 1）。
接受DAIR治疗的THA因任何原因进行翻修的频率高于对照队列中的THA。差异主要由感染性失败引起。PJI治愈后，无菌性松动翻修的差异不显著。队列之间任何部件松动的影像学证据没有显著差异。这些数据表明，先前接受DAIR治疗且已治愈的髋关节PJI因无菌性原因失败的频率并不高于未接受DAIR治疗的THA。
