Vees Tilman, Hofmann Gunther O
Clinic of Trauma, Hand und Reconstructive Surgery, Friedrich-Schiller-University Jena, Germany.
Department for Septic and Reconstructive Surgery, Clinic for Trauma and Reconstructive Surgery, BG-Kliniken Bergmannstrost, Halle (Saale), Germany.
GMS Interdiscip Plast Reconstr Surg DGPW. 2020 Oct 28;9:Doc03. doi: 10.3205/iprs000147. eCollection 2020.
Periprosthetic infections (PPI) after total hip and total knee arthroplasty (THA, TKA) are subdivided into early and late infections. Early PPIs are defined as the occurrence of infection within 6 weeks following the primary surgery. Aim of therapy in early PPI is the retention of the prosthesis using dilution, jet dilution or local antibiotics. However, as of yet, no evidence is available supporting these procedures. The aim of this study was to evaluate their success rates. We conducted a systematic literature review of studies reporting on early PPI. Clinical trials published after 1990 that reported success or failure rates as the primary outcome were included. A meta-analysis using the Scheffé-Test showed if there are any advantages of single treatment concepts. We identified 575 patients over 10 studies. Success rates were diverse: Undergoing dilution without jet lavage revealed treatment success in 49.48%, using jet dilution increased the success rate to 78.26%. Local antibiotics were successfully used in 55% of the cases. The meta-analysis compared the three interventions and showed no significant difference in using dilution, jet dilution or local antibiotics. Even combining local antibiotics and dilution/jet dilution does not provide significantly higher success rates. Previous studies showed differences in methods and results, however pooling the data of these studies for our meta-analysis didn't show significant advantages. We therefore conclude that studies conducted until thus far cannot provide any recommendation as to whether using dilution, jet dilution, local antibiotics or any combination of three is better for treating early PPI cases.
全髋关节置换术（THA）和全膝关节置换术（TKA）后的假体周围感染（PPI）可分为早期感染和晚期感染。早期PPI被定义为初次手术后6周内发生的感染。早期PPI的治疗目标是通过稀释、喷射冲洗或局部使用抗生素来保留假体。然而，目前尚无证据支持这些治疗方法。本研究的目的是评估它们的成功率。我们对报告早期PPI的研究进行了系统的文献综述。纳入1990年后发表的以成功率或失败率作为主要结局的临床试验。使用谢费检验进行荟萃分析，以显示单一治疗方案是否具有任何优势。我们在10项研究中确定了575例患者。成功率各不相同：未进行喷射灌洗的单纯稀释治疗成功率为49.48%，使用喷射冲洗可将成功率提高至78.26%。局部使用抗生素的成功率为55%。荟萃分析比较了这三种干预措施，结果显示在使用稀释、喷射冲洗或局部使用抗生素方面没有显著差异。即使将局部使用抗生素与稀释/喷射冲洗联合使用，也不会显著提高成功率。以往的研究在方法和结果上存在差异，然而，将这些研究的数据汇总用于我们的荟萃分析并未显示出显著优势。因此，我们得出结论，就治疗早期PPI病例而言，使用稀释、喷射冲洗、局部使用抗生素或三者的任何组合是否更好，目前为止所进行的研究均无法给出任何建议。
