Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
Bone Joint J. 2020 Dec;102-B(12):1662-1669. doi: 10.1302/0301-620X.102B12.BJJ-2020-0501.R1.
To compare the functional outcome, health-related quality of life (HRQoL), and satisfaction of patients who underwent primary total hip arthroplasty (THA) and a single debridement, antibiotics and implant retention (DAIR) procedure for deep infection, using either the transgluteal or the posterior surgical approach for both procedures.
The study was registered at clinicaltrials.gov (ID: NCT03161990) on 15 May 2017. Patients treated with a single DAIR procedure for deep infection through the same operative approach as their primary THA (either the transgluteal or the posterior approach) were identified in the Norwegian Arthroplasty Register and given a questionnaire. Median follow-up after DAIR by questionnaire was 5.5 years in the transgluteal group (n = 87) and 2.5 years in the posterior approach group (n = 102).
Patients in the posterior approach group were less likely to limp after the DAIR procedure (17% vs 36% limped all the time; p = 0.005), had a higher mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (80 vs 71; p = 0.013), and were more likely to achieve a patient acceptable symptom state for the WOMAC function score (76% vs 55%; p = 0.002). In a multivariable analysis, the point estimate for the increase in WOMAC function score using the posterior approach was 10.2 (95% CI 3.1 to 17.2; p = 0.005), which is above the minimal clinically important improvement. The patients in the posterior approach group also reported better mean HRQoL scores and were more likely to be satisfied with their hip arthroplasty (77% vs 55%; p = 0.001).
In patients treated with a single, successful DAIR procedure for deep infection of a primary THA, the use of the posterior approach in both primary surgery and DAIR was associated with less limping, better functional outcome, better HRQoL, and higher patient satisfaction compared with cases where both were performed using the transgluteal approach. The observed differences in functional outcome and patient satisfaction were clinically relevant. Cite this article: 2020;102-B(12):1662-1669.
比较初次全髋关节置换术（THA）和单次清创术、抗生素保留和植入物保留（DAIR）治疗深部感染的患者的功能结果、健康相关生活质量（HRQoL）和满意度，这些患者使用经臀或后路进行初次手术和 DAIR 手术。
本研究于 2017 年 5 月 15 日在 clinicaltrials.gov 注册（ID：NCT03161990）。在挪威关节置换登记处中确定了通过与初次 THA 相同手术入路（经臀或后路）接受单次 DAIR 治疗深部感染的患者，并向他们发放问卷。经臀组（n=87）和后路组（n=102）的 DAIR 后中位随访时间分别为 5.5 年和 2.5 年。
后路组患者在 DAIR 手术后跛行的可能性较小（17% vs. 36%一直跛行；p=0.005），WOMAC 功能评分的平均均值较高（80 分 vs. 71 分；p=0.013），且 WOMAC 功能评分达到患者可接受的症状状态的可能性更高（76% vs. 55%；p=0.002）。在多变量分析中，后路入路组 WOMAC 功能评分的增加点估计值为 10.2（95%CI 3.1 至 17.2；p=0.005），高于最小临床重要改善值。后路组患者的 HRQoL 评分也较高，对髋关节置换术的满意度更高（77% vs. 55%；p=0.001）。
在初次 THA 深部感染单次成功 DAIR 治疗的患者中，后路入路用于初次手术和 DAIR 与经臀入路相比，跛行程度较轻，功能结果更好，HRQoL 更高，患者满意度更高。在功能结果和患者满意度方面观察到的差异具有临床意义。引用本文： 2020；102-B（12）：1662-1669。
