Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
J Arthroplasty. 2021 May;36(5):1765-1771. doi: 10.1016/j.arth.2020.11.033. Epub 2020 Dec 1.
Irrigation and debridement with modular component exchange is appealing for surgeons to treat early-stage periprosthetic joint infection (PJI). However, the indication, perioperative protocol, and success rate remain controversial. This study is the first one to present results of debridement, antibiotics, and implant retention (DAIR) with integrated MIT (modular component exchange, povidone-iodine and topical antibiotics delivery) protocol for treating PJI occurring within 3 months since the primary total joint arthroplasty.
We retrospectively analyzed patients who received DAIR with MIT protocol in our department between January 2011 and May 2018. Topical antibiotics were delivered in all cases. Topical antibiotics infusion was applied for those infected with multidrug-resistant bacteria, fungus, polymicrobial infection, and culture negative one. Failure was defined as additional surgical intervention for infection after DAIR; persistent sinus tract, drainage or excessive joint pain; need for suppressive antibiotics therapy due to the infection; infection relapse with the same pathogen; reinfection with different microorganism; and infection-related death.
A total of 73 patients with a mean age of 63.30 ± 10.97 years were included in this study, including 43 men and 30 women. There are 41 knees and 32 hips. Thirty patients had sinus tract. With a mean follow-up of 63.79 ± 18.57 months, there were 9 failures in total with an overall success rate of 87.67%. The success rate was 88.57% and 86.84% for those receiving topical antibiotics infusion postoperatively and those without.
DAIR with a standard MIT protocol is a viable and safe option for PJI occurring within 3 months since the primary total joint arthroplasty.
Level 4, therapeutic study.
对于治疗早期假体周围关节感染（PJI），带模块化组件交换的灌洗和清创术对外科医生很有吸引力。然而，适应证、围手术期方案和成功率仍存在争议。本研究首次介绍了在初次全关节置换术后 3 个月内发生的 PJI 采用保留假体的清创术、抗生素和植入物（DAIR）联合 MIT（模块化组件交换、聚维酮碘和局部抗生素输送）方案的治疗结果。
我们回顾性分析了 2011 年 1 月至 2018 年 5 月期间在我科接受 MIT 方案 DAIR 治疗的患者。所有病例均采用局部抗生素治疗。对于感染耐多药菌、真菌、混合感染和培养阴性的患者，应用局部抗生素灌注。DAIR 后再次出现感染需手术干预、持续窦道、引流或关节疼痛明显、因感染需要持续应用抗生素、感染复发且病原体相同、感染再发且病原体不同、感染相关死亡定义为治疗失败。
本研究共纳入 73 例患者，平均年龄为 63.30±10.97 岁，男 43 例，女 30 例；41 例为膝关节，32 例为髋关节；30 例存在窦道。平均随访 63.79±18.57 个月，共有 9 例失败，总体成功率为 87.67%。术后行局部抗生素灌注和未行局部抗生素灌注的患者成功率分别为 88.57%和 86.84%。
对于初次全关节置换术后 3 个月内发生的 PJI，采用标准 MIT 方案的 DAIR 是一种可行且安全的选择。
4 级，治疗性研究。
