Nurmohamed F Ruben H A, van Dijk Bruce, Veltman Ewout S, Hoekstra Marrit, Rentenaar Rob J, Weinans Harrie H, Vogely H Charles, van der Wal Bart C H
Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.
J Bone Jt Infect. 2021 Jan 27;6(4):91-97. doi: 10.5194/jbji-6-91-2021. eCollection 2021.
: Debridement, antibiotics and implant retention (DAIR) procedures are effective treatments for acute postoperative or acute hematogenous periprosthetic joint infections. However, literature reporting on the effectiveness of DAIR procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI) (PJI-related revision arthroplasty) is scarce. The aim of this study is to retrospectively evaluate the infection control after 1 year of a DAIR procedure in the case of an early postoperative infection either after primary arthroplasty or after PJI-related revision arthroplasty. : All patients treated with a DAIR procedure within 3 months after onset of PJI between 2009 and 2017 were retrospectively included. Data were collected on patient and infection characteristics. All infections were confirmed by applying the Musculoskeletal Infection Society (MSIS) 2014 criteria. The primary outcome was successful control of infection at 1 year after a DAIR procedure, which was defined as the absence of clinical signs, such as pain, swelling, and erythema; radiological signs, such as protheses loosening; or laboratory signs, such as C-reactive protein (CRP) ( ) with no use of antibiotic therapy. : Sixty-seven patients were treated with a DAIR procedure (41 hips and 26 knees). Successful infection control rates of a DAIR procedure after primary arthroplasty ( ) and after prior PJI-related revision arthroplasty ( ) were 69 % and 56 %, respectively ( ). The successful infection control rates of a DAIR procedure after an early acute infection ( ) and after a hematogenous infection ( ) following primary arthroplasty were both 69 % ( ). : In this limited study population, no statistically significant difference is found in infection control after 1 year between DAIR procedures after primary arthroplasty and PJI-related revision arthroplasty.
清创、抗生素及保留植入物(DAIR)手术是治疗急性术后或急性血源性人工关节感染的有效方法。然而,关于因人工关节感染(PJI)进行一期或二期翻修术后(PJI相关翻修关节成形术)实施DAIR手术有效性的文献报道较少。本研究的目的是回顾性评估在初次关节成形术后或PJI相关翻修关节成形术后早期发生术后感染的情况下,DAIR手术1年后的感染控制情况。
纳入2009年至2017年间在PJI发病后3个月内接受DAIR手术治疗的所有患者。收集患者及感染特征的数据。所有感染均依据肌肉骨骼感染学会(MSIS)2014年标准确诊。主要结局是DAIR手术后1年感染得到成功控制,定义为无疼痛、肿胀、红斑等临床症状;无假体松动等放射学表现;或在未使用抗生素治疗的情况下C反应蛋白(CRP)等实验室指标正常。
67例患者接受了DAIR手术(41例髋关节和26例膝关节)。初次关节成形术后DAIR手术的成功感染控制率( )和先前PJI相关翻修关节成形术后DAIR手术的成功感染控制率( )分别为69%和56%( )。初次关节成形术后早期急性感染( )和血源性感染( )后DAIR手术的成功感染控制率均为69%( )。
在这个有限的研究人群中,初次关节成形术后DAIR手术和PJI相关翻修关节成形术后1年的感染控制情况在统计学上无显著差异。