Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, Boston, MA.
J Arthroplasty. 2021 Mar;36(3):1094-1100. doi: 10.1016/j.arth.2020.09.012. Epub 2020 Sep 14.
Patients undergoing a 2-stage revision for periprosthetic joint infection (PJI) often require a repeat spacer in the interim due to persistent infection. This study aims to report outcomes for patients with repeat spacer exchange and to identify risk factors associated with interim spacer exchange in 2-stage revision arthroplasty.
A total of 256 consecutive 2-stage revisions for chronic infection of total hip arthroplasty and total knee arthroplasty with reimplantation and minimum 2-year follow-up were investigated. An interim spacer exchange was performed in 49 patients (exchange cohort), and these patients were propensity score matched to 196 patients (nonexchange cohort). Multivariate analysis was performed to analyze risk factors for failure of interim spacer exchange.
Patients in the propensity score-matched exchange cohort demonstrated a significantly increased reinfection risk compared to patients without interim spacer exchange (24% vs 15%, P = .03). Patients in the propensity score-matched exchange cohort showed significantly lower postoperative scores for 3 patient-reported outcome measures (PROMs): hip disability and osteoarthritis outcome score physical function (46.0 vs 54.9, P = .01); knee disability and osteoarthritis outcome score physical function (43.1 vs 51.7, P < .01); and patient-reported outcomes measurement information system physical function short form (41.6 vs 47.0, P = .03). Multivariate analysis demonstrated Charles Comorbidity Index (odds ratio, 1.56; P = .01) and the presence of Enterococcus species (odds ratio, 1.43; P = .03) as independent risk factors associated with 2-stage reimplantation requiring an interim spacer exchange for periprosthetic joint infection.
This study demonstrates that patients with spacer exchange had a significantly higher risk of reinfection at 2 years of follow-up. Additionally, patients with spacer exchange demonstrated lower postoperative PROM scores and diminished improvement in multiple PROM scores after reimplantation, indicating that an interim spacer exchange in 2-stage revision is associated with worse patient outcomes.
接受 2 期翻修的假体周围关节感染（PJI）患者由于持续感染，通常需要在中期重复使用间隔器。本研究旨在报告接受重复间隔器交换的患者的结果，并确定 2 期翻修关节置换术中与中期间隔器交换相关的风险因素。
共调查了 256 例因全髋关节置换术和全膝关节置换术慢性感染而接受 2 期翻修并进行再植入的连续病例，随访时间至少 2 年。49 例患者（交换组）进行了中期间隔器交换，这些患者与 196 例患者（非交换组）进行了倾向评分匹配。进行多变量分析以分析中期间隔器交换失败的风险因素。
在倾向评分匹配的交换组中，与无中期间隔器交换的患者相比，再感染风险显著增加（24% vs. 15%，P=0.03）。在倾向评分匹配的交换组中，3 项患者报告的结局测量（PROMs）的术后评分显著降低：髋关节残疾和骨关节炎结局评分躯体功能（46.0 分 vs. 54.9 分，P=0.01）；膝关节残疾和骨关节炎结局评分躯体功能（43.1 分 vs. 51.7 分，P<0.01）；以及患者报告的结局测量信息系统躯体功能简短形式（41.6 分 vs. 47.0 分，P=0.03）。多变量分析表明，Charlson 合并症指数（比值比，1.56；P=0.01）和肠球菌属物种的存在（比值比，1.43；P=0.03）是与假体周围关节感染需要 2 期再植入的中期间隔器交换相关的独立风险因素。
本研究表明，在 2 年随访时，接受间隔器交换的患者再感染的风险显著增加。此外，接受间隔器交换的患者术后 PROM 评分较低，并且在再植入后多个 PROM 评分的改善程度降低，这表明 2 期翻修中的中期间隔器交换与患者结局较差相关。
