Department of Orthopaedic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Pathology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Orthop Surg. 2021 May;13(3):884-891. doi: 10.1111/os.12996. Epub 2021 Mar 25.
To evaluated the clinical outcomes of periprosthetic joint infection (PJI) patients with destination joint spacer compared with that of two-stage revision.
From January 2006 to December 2017, data of PJI patients who underwent implantation with antibiotic-impregnated cement spacers in our center due to chronic PJI were collected retrospectively. The diagnosis of PJI was based on the American Society for Musculoskeletal Infection (MSIS) criteria for PJI. One of the following must be met for diagnosis of PJI: a sinus tract communicating with the prosthesis; a pathogenis isolated by culture from two separate tissue or fluid samples obtained from the affected prosthetic joint; four of the following six criteria exist: (i) elevated ESR and CRP; (ii) elevate dsynovial fluid white blood cell (WBC) count; (iii) elevated synovial fluid neutrophil percentage (PMN%); (iv) presence of purulence in the affected joint; (v) isolation of a microorganism in one periprosthetic tissue or fluid culture; (vi) more than five neutrophilsper high-power fields in five high-power fields observed from histological analysis of periprosthetic tissue at ×400 magnification. Age, sex, body mass index (BMI), and laboratory test results were recorded. All patients were followed up regularly after surgery, the infection-relief rates were recorded, Harris hip score (HHS) and knee society score (KSS) were used for functional evaluation, a Doppler ultrasonography of the lower limb veins was performed for complication evaluation. The infection-relief rates and complications were compared between destination joint spacer group and two-stage revision group.
A total of 62 patients who were diagnosed with chronic PJI were enrolled, with an age of 65.13 ± 9.94 (39-88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group, namely, two-stage revision group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group, and this might be the primary reason for joint spacer retainment. As for infection-relief rate, there were three cases of recurrent infection (14.29%) in the destination joint spacer group and four cases of recurrent infection (9.76%) in the two-stage revision group, there were no significant differences with regard to infection-relief rate. Moreover, there two patients who suffered from spacer fractures, three cases of dislocation, one case of a periarticular fracture, and three cases of deep venous thrombosis in destination joint spacer group, while there was only one case of periprosthetic hip joint fracture, one case of dislocation, and one patient suffered from deep venous thrombosis of the lower extremity in two-stage revision. The incidence of complications in the destination joint spacer group was higher than that of two-stage revision.
In summary, the present work showed that a destination joint spacer might be provided as a last resort for certain PJI patients due to similar infection-relief rate compared with two-stage revision.
评估使用假体关节内留置抗生素骨水泥 spacer 治疗假体周围关节感染（PJI）患者的临床疗效，与二期翻修相比。
回顾性收集 2006 年 1 月至 2017 年 12 月期间，因慢性 PJI 在我院行抗生素骨水泥 spacer 植入的 PJI 患者的临床资料。PJI 的诊断基于美国矫形感染学会（MSIS）PJI 诊断标准：（1）假体周围有窦道与假体相通；（2）从受累假体关节的 2 份不同组织或液体样本中分离出病原体；（3）符合以下 6 项标准中的 4 项：①ESR 和 CRP 升高；②关节液白细胞（WBC）计数升高；③关节液中性粒细胞百分比（PMN%）升高；④受累关节有脓性分泌物；⑤假体周围组织或关节液培养分离出微生物；⑤在受累假体组织的 5 个高倍视野中，每个高倍视野观察到超过 5 个中性粒细胞。记录患者的年龄、性别、体重指数（BMI）和实验室检查结果。所有患者术后均定期随访，记录感染缓解率，采用 Harris 髋关节评分（HHS）和膝关节学会评分（KSS）进行功能评估，采用下肢静脉多普勒超声检查评估并发症。比较假体关节内留置 spacer 组和二期翻修组的感染缓解率和并发症。
共纳入 62 例慢性 PJI 患者，年龄 65.13±9.94（39-88）岁。其中假体关节内留置 spacer 组 21 例，二期翻修组（感染缓解后再次植入假体）41 例。假体关节内留置 spacer 组Charlson 合并症指数（CCI）高于二期翻修组，这可能是保留假体关节内留置 spacer 的主要原因。感染缓解率方面，假体关节内留置 spacer 组有 3 例（14.29%）复发感染，二期翻修组有 4 例（9.76%）复发感染，差异无统计学意义。此外，假体关节内留置 spacer 组有 2 例发生 spacer 骨折，3 例发生脱位，1 例发生关节周围骨折，3 例发生下肢深静脉血栓形成，二期翻修组仅有 1 例发生假体周围髋关节骨折，1 例发生脱位，1 例发生下肢深静脉血栓形成。假体关节内留置 spacer 组并发症发生率高于二期翻修组。
综上所述，本研究表明，对于某些 PJI 患者，由于与二期翻修相比感染缓解率相似，假体关节内留置 spacer 可能是一种最后的治疗选择。
