Cichos Kyle H, Detweiler Maxwell, Parvizi Javad, McGwin Gerald, Heatherly Alex R, Ghanem Elie S
Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Hip Int. 2022 Jan;32(1):17-24. doi: 10.1177/1120700020936628. Epub 2020 Jun 23.
The objectives of this study are to report the rates of positive intraoperative cultures obtained during conversion total hip arthroplasty (THA) according to index surgery, and to describe the natural history of treatment for a consecutive series of patients with unexpected positive intraoperative cultures during conversion THA.
We reviewed all patients at 2 institutions undergoing conversion THA from prior open reduction and internal fixation (ORIF) of acetabular and hip fractures or hemiarthroplasty for displaced femoral neck fractures from 2011 to 2018. Intraoperative cultures were taken in 105 patients. Positive intraoperative cultures during conversion were recorded and managed with an infectious diseases consult. The outcomes including PJI at 90 days and 1 year follow-up were documented.
Overall, 19 of 105 patients (18%) undergoing conversion THA had positive intraoperative cultures, with the highest rates in the hemiarthroplasty 7/16 (44%) and acetabular ORIF 9/48 (19%) groups. All 19 patients were initially treated conservatively: 8 received IV antibiotics, 10 received no additional therapy, and 1 received oral antibiotics. 4/9 acetabular fracture conversions developed PJI at 1 year, with 3 requiring multiple irrigation and debridement/polyethylene exchanges to control the infection while the 4th patient required 2-stage exchange. There were no 1-year PJI from any of the other index procedures after conversion. All 7 hemiarthroplasty patients with positive cultures were treated to resolution with 4-8 weeks IV antibiotics alone.
Patients undergoing conversion THA from prior hip or acetabular fracture have a high rate of positive intraoperative cultures. As such, all patients undergoing conversion THA from prior hip or acetabular fracture fixation should undergo thorough diagnostic workup prior to surgery, and have intraoperative cultures obtained during surgery if infection remains suspicious. Further work should be performed to develop MSIS criteria for preoperative management of patients undergoing conversion THA.
本研究的目的是报告根据初次手术情况，在全髋关节置换术（THA）翻修术中获得的术中培养阳性率，并描述在THA翻修术中一系列术中培养意外阳性患者的自然治疗过程。
我们回顾了2011年至2018年期间在2家机构接受THA翻修术的所有患者，这些患者之前接受过髋臼和髋部骨折的切开复位内固定术（ORIF）或移位股骨颈骨折的半髋关节置换术。105例患者进行了术中培养。记录翻修术中的术中培养阳性情况，并通过感染病会诊进行处理。记录包括90天和1年随访时的假体周围感染（PJI）等结果。
总体而言，105例接受THA翻修术的患者中有19例（18%）术中培养阳性，其中半髋关节置换术组7/16（44%）和髋臼ORIF组9/48（19%）的阳性率最高。所有19例患者最初均接受保守治疗：8例接受静脉抗生素治疗，10例未接受额外治疗，1例接受口服抗生素治疗。4/9例髋臼骨折翻修患者在1年时发生PJI，其中3例需要多次冲洗清创/聚乙烯内衬更换以控制感染，第4例患者需要二期翻修。翻修后其他任何初次手术的患者在1年时均未发生PJI。所有7例培养阳性的半髋关节置换术患者仅通过4 - 8周的静脉抗生素治疗即治愈。
既往有髋部或髋臼骨折行THA翻修术的患者术中培养阳性率较高。因此，所有既往有髋部或髋臼骨折内固定术而行THA翻修术的患者在手术前应进行全面的诊断检查，如果仍怀疑有感染，术中应进行培养。应进一步开展工作，制定用于THA翻修术患者术前管理的肌肉骨骼感染学会（MSIS）标准。
