Northern Ontario School of Medicine, Thunder Bay, ON, Canada.
Division of Orthopaedics, Department of Surgery, Center for Evidence-Based Orthopaedics, St. Joseph's Hospital, McMaster University, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
Eur J Orthop Surg Traumatol. 2020 Oct;30(7):1139-1149. doi: 10.1007/s00590-020-02699-y. Epub 2020 May 13.
Endoprosthetic reconstructions have become increasingly common in the setting of significant bone loss. Indications include revision arthroplasty, trauma, and reconstruction in the setting of primary malignancies or bony metastases. Although the use of endoprostheses has several advantages, they carry a high risk of infection. The purpose of this review is to determine the success rates of surgical management of infected endoprostheses.
The authors searched databases for relevant studies and screened in duplicate. Data extracted included overall infection rate, timing of infection, follow-up, isolated pathogen and operative treatment strategy, and subsequent failure rate. The overall quality of the evidence with the Methodological Index for non-randomized studies criteria.
A total of 16 studies and 647 patients met the inclusion criteria. 400 patients had operative management and reported outcomes. Failure rates of patients undergoing debridement, antibiotics, and implant retention (DAIR) were 55.1%. Failure rates of patients who underwent one-stage revision were 45.5%. Failure rates of patients undergoing two-stage revision were 27.3%. Failure occurred at 31.4 months (range, 0-228) postoperatively.
Rates of periprosthetic joint infection remain high in endoprosthetic reconstructions. Although DAIR procedures were found to have a low success rate, they remain a reasonable option in acute infections given the morbidity of staged revisions. There is a lack of comparative data in the current literature and the heterogeneity and low level of evidence does not allow for between group comparisons of results.
在严重骨质流失的情况下，内置假体重建变得越来越普遍。其适应证包括翻修关节成形术、创伤以及原发性恶性肿瘤或骨转移的重建。尽管内置假体具有许多优点，但它们存在很高的感染风险。本综述的目的是确定感染性内置假体手术治疗的成功率。
作者在数据库中搜索了相关研究，并进行了重复筛选。提取的数据包括总感染率、感染时间、随访、分离病原体和手术治疗策略以及随后的失败率。使用非随机研究方法学指数标准评估证据的总体质量。
共有 16 项研究和 647 名患者符合纳入标准。400 名患者接受了手术治疗并报告了结果。接受清创术、抗生素和保留植入物（DAIR）治疗的患者失败率为 55.1%。接受一期翻修的患者失败率为 45.5%。接受二期翻修的患者失败率为 27.3%。术后失败时间为 31.4 个月（范围 0-228 个月）。
内置假体重建术后的假体周围关节感染率仍然很高。尽管 DAIR 手术的成功率较低，但考虑到分期翻修的发病率，对于急性感染，它们仍然是一种合理的选择。目前文献中缺乏比较数据，且异质性和低证据水平不允许对结果进行组间比较。
