Oe Kenichi, Sawada Masahiro, Nakamura Tomohisa, Iida Hirokazu, Saito Takanori
Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, JPN.
Cureus. 2021 Jun 22;13(6):e15842. doi: 10.7759/cureus.15842. eCollection 2021 Jun.
Introduction Management of periprosthetic hip infections (PHIs) generally consists of implant removal and thorough debridement, accompanied by appropriate antibiotic therapy. Daptomycin (DAP) is a novel antibiotic, which allowed for implant retention in several patients after treating their infected joints. However, there is no consensus about implant retention or removal during the treatment of PHIs. The aim of this study was to examine the effect of DAP and to determine a surgical treatment strategy. Methods This study retrospectively evaluated 20 patients between August 2014 and December 2018, divided into implant retention (n=9) and implant removal groups (n=11). Infection control and risk of recurrent infection were evaluated. Infection control was defined as not requiring implant removal after the final treatment. Results Infection control rates in implant retention and implant removal groups were 67% and 90%, respectively. All late chronic infections resulted in failure cases within the implant retention group. In the implant retention group, mean preoperative risk scores for successful cases were significantly higher than those for failure cases (p<0.05). Conclusions Patients with low risk did not require implant removal, suggesting that DAP may be a breakthrough alternative to traditional PHI management.
引言
人工髋关节周围感染（PHIs）的管理通常包括取出植入物和彻底清创，并辅以适当的抗生素治疗。达托霉素（DAP）是一种新型抗生素，在治疗感染关节后，使得部分患者能够保留植入物。然而，在PHIs治疗期间，对于植入物的保留或取出尚无共识。本研究的目的是检验DAP的效果并确定手术治疗策略。
方法
本研究回顾性评估了2014年8月至2018年12月期间的20例患者，分为植入物保留组（n = 9）和植入物取出组（n = 11）。评估感染控制情况和再次感染的风险。感染控制定义为最终治疗后无需取出植入物。
结果
植入物保留组和植入物取出组的感染控制率分别为67%和90%。所有晚期慢性感染均导致植入物保留组出现失败病例。在植入物保留组中，成功病例的术前平均风险评分显著高于失败病例（p<0.05）。
结论
低风险患者无需取出植入物，这表明DAP可能是传统PHI管理的一种突破性替代方案。
