Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Bone Joint J. 2020 Dec;102-B(12):1682-1688. doi: 10.1302/0301-620X.102B12.BJJ-2020-0792.R1.
The success rates of two-stage revision arthroplasty for infection have evolved since their early description. The implementation of internationally accepted outcome criteria led to the readjustment of such rates. However, patients who do not undergo reimplantation are usually set aside from these calculations. The aim of this study was to investigate the outcomes of two-stage revision arthroplasty when considering those who do not undergo reimplantation, and to investigate the characteristics of this subgroup.
A retrospective cohort study was conducted. Patients with chronic hip or knee periprosthetic joint infection (PJI) treated with two-stage revision between January 2010 and October 2018, with a minimum follow-up of one year, were included. Variables including demography, morbidity, microbiology, and outcome were collected. The primary endpoint was the eradication of infection. Patients who did not undergo reimplantation were analyzed in order to characterize this subgroup better.
A total of 162 chronic PJIs were included in the study. After a mean follow-up of 57.3 months (12.1 to 115.7), 18 patients (11.1%) did not undergo reimplantation, due either to medical issues (10), the patient's choice (4), or death (4). When only considering those who underwent reimplantation, the success rate was 80.6%. However, when those who did not undergo reimplantation were included, the success rate dropped to 71.6%. Advanced age, American Society of Anesthesiologists grade ≥ III, McPherson's C host, and Gram-negative related PJI were independent risk factors for retention of the spacer. The mortality was higher in the non-reimplanted group.
The real success rate of two-stage revision may not be as high as previously reported. The exclusion of patients who do not undergo reimplantation resulted in a 9% overestimation of the success rate in this series. Many comorbidity-related risk factors for retention of the spacer were identified, as well as higher death rates in this group. Efforts should be made to optimize these patients medically in order to increase reimplantation and success rates, while decreasing mortality. Cite this article: 2020;102-B(12):1682-1688.
自早期描述以来，二期翻修关节置换术治疗感染的成功率已经发生了变化。国际公认的疗效标准的实施导致了这些成功率的重新调整。然而，那些未进行再植入的患者通常不包括在这些计算中。本研究的目的是调查在考虑未进行再植入的情况下，二期翻修关节置换术的结果，并研究这一亚组的特征。
本研究采用回顾性队列研究。纳入 2010 年 1 月至 2018 年 10 月期间接受二期翻修治疗的慢性髋或膝关节假体周围关节感染（PJI）患者，随访至少 1 年。收集了人口统计学、发病率、微生物学和疗效等变量。主要终点是感染的消除。分析了未进行再植入的患者，以更好地描述这一亚组。
本研究共纳入 162 例慢性 PJI。平均随访 57.3 个月（12.1-115.7）后，18 例（11.1%）患者未进行再植入，原因分别为医学问题（10 例）、患者选择（4 例）或死亡（4 例）。仅考虑进行再植入的患者时，成功率为 80.6%。然而，当包括未进行再植入的患者时，成功率降至 71.6%。高龄、美国麻醉医师协会分级≥III 级、麦克弗森 C 型宿主和革兰阴性相关 PJI 是保留间隔器的独立危险因素。未再植入组的死亡率较高。
二期翻修的实际成功率可能不如之前报道的那么高。本研究中，由于排除了未进行再植入的患者，成功率高估了 9%。确定了许多与保留间隔器相关的合并症危险因素，且该组死亡率较高。应努力改善这些患者的医疗状况，以提高再植入率和成功率，同时降低死亡率。
