From the Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, Boston, MA.
J Am Acad Orthop Surg. 2021 Dec 1;29(23):1024-1030. doi: 10.5435/JAAOS-D-20-00939.
Acute hematogenous periprosthetic joint infections (PJI) accounts for 20% to 35% of all PJI cases. Treatment options include débridement, antibiotics, and implant retention (DAIR) or implant revision (single-stage/two-stage revision). Because the reported success rates of DAIR for acute PJIs as reported in the literature varies widely, this study aimed to investigate (1) the outcome of DAIR as revision surgery procedure and (2) the potential risk factors for treatment failure of DAIR in patients with acute hematogenous PJI.
We reviewed 106 consecutive cases of total joint arthroplasty patients who underwent DAIR for the diagnosis of acute hematogenous PJI. Outcomes of the cohort including infection free survival was investigated. Mean follow-up was 4.9 years. Demographics, case data, comorbidities, and extremity score were analyzed by univariate and multivariate regressions to identify risk factors for failure of DAIR.
The failure rate of patients who underwent DAIR was 23.6% (25 of 106 patients). Univariate regression demonstrated that diabetes mellitus (P = 0.01) and polymicrobial infections (P < 0.01) are associated with failure of DAIR. Multivariate regression confirmed diabetes mellitus and polymicrobial infections as independent risk factors for failure of DAIR.
Debridement, antibiotics, and implant retention may be a viable treatment option with moderate failure rates at the midterm follow-up in cases of acute hematogenous PJI. The study also identified diabetes mellitus and polymicrobial infections as independent risk factors for failure of DAIR. The findings of this study provide clinically useful information for surgeons in treatment of patients with acute hematogenous PJI.
急性血源性假体周围关节感染（PJI）占所有 PJI 病例的 20%至 35%。治疗方案包括清创术、抗生素和保留植入物（DAIR）或植入物翻修（一期/二期翻修）。由于文献中报道的急性 PJI 行 DAIR 的成功率差异很大，本研究旨在探讨（1）DAIR 作为翻修手术的结果，以及（2）急性血源性 PJI 患者行 DAIR 治疗失败的潜在危险因素。
我们回顾了 106 例接受 DAIR 诊断为急性血源性 PJI 的全关节置换术患者的连续病例。调查了该队列的结局，包括感染无生存情况。平均随访时间为 4.9 年。通过单变量和多变量回归分析了人口统计学、病例数据、合并症和肢体评分，以确定 DAIR 失败的危险因素。
接受 DAIR 的患者失败率为 23.6%（106 例患者中有 25 例）。单变量回归表明，糖尿病（P=0.01）和混合微生物感染（P<0.01）与 DAIR 失败相关。多变量回归证实糖尿病和混合微生物感染是 DAIR 失败的独立危险因素。
清创术、抗生素和保留植入物可能是急性血源性 PJI 的一种可行治疗选择，在中期随访中失败率中等。本研究还确定了糖尿病和混合微生物感染是 DAIR 失败的独立危险因素。本研究的结果为急性血源性 PJI 患者的外科医生提供了临床有用的信息。
