Li Katherine, Cuadra Mario, Scarola Gregory, Odum Susan, Otero Jesse, Griffin William, Springer Bryan D
Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1025 Morehead Medical Dr., Suite 300, Charlotte, NC 28203, USA.
Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1320 Scott Ave., Charlotte, NC 28204, USA.
J Bone Jt Infect. 2021 Jul 29;6(7):295-303. doi: 10.5194/jbji-6-295-2021. eCollection 2021.
Prosthetic joint infection (PJI) is a devastating complication after total hip arthroplasty (THA). The common treatment in the USA is a two-stage exchange which can be associated with significant morbidity and mortality. The purpose of this study was to analyze complications in the treatment course of patients undergoing two-stage exchange for PJI THA and determine when they occur. We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI after THA from January 2005 to January 2018 at a single institution. Complications were categorized as medical or surgical and divided into interstage and post-reimplantation. Minimum follow-up was 1 year. Success was based on the MusculoSkeletal Infection Society (MSIS) definition. : 205 hips (203 patients) underwent first stage of planned two-stage exchange. The median age was 68 (interquartile range (IQR) 18). There were 97 males and 106 females. Overall, 73/205 (38 %) patients had at least one complication during treatment: 13.5 % (25/185) of patients experienced a medical complication and 28.1 % (52/185) a surgical complication; 2.4 % died within 1 year of surgery, and 4.9 % (15/203) had mortality at a median of 2.5 years (IQR 4.9); 27 % of patients had complications during the interstage period, most commonly being recurrence of infection requiring additional surgery (63 %); and 14 % of patients experienced a complication following reimplantation, most commonly persistence or recurrence of infection (59 %). While 92 % of patients that initiated treatment were ultimately reimplanted, only 69 % were infection free at 1 year and required no additional treatment. : While two-stage exchanges for PJI in THA have been reported as successful, there are few reports of the complications during the process. In our series, significant numbers of patients experienced complications, often during the interstage period, highlighting the morbidity of this method of treatment.
人工关节感染（PJI）是全髋关节置换术（THA）后一种极具破坏性的并发症。在美国，常见的治疗方法是两阶段翻修术，这可能会导致显著的发病率和死亡率。本研究的目的是分析接受两阶段翻修术治疗PJI-THA患者治疗过程中的并发症，并确定其发生时间。我们分析了2005年1月至2018年1月在单一机构接受两阶段翻修术治疗THA后PJI的所有患者。并发症分为医疗性或手术性，并分为两期之间和再次植入后。最短随访时间为1年。成功的定义基于肌肉骨骼感染协会（MSIS）的标准。205髋（203例患者）接受了计划两阶段翻修术的第一阶段。中位年龄为68岁（四分位间距（IQR）为18）。男性97例，女性106例。总体而言，73/205（38%）的患者在治疗期间至少出现一种并发症：13.5%（25/185）的患者出现医疗并发症，28.1%（52/185）的患者出现手术并发症；2.4%的患者在术后1年内死亡，4.9%（15/203）的患者在中位时间2.5年（IQR为4.9）时死亡；27%的患者在两期之间出现并发症，最常见的是感染复发需要再次手术（63%）；14%的患者在再次植入后出现并发症，最常见的是感染持续或复发（59%）。虽然开始治疗的患者中有92%最终进行了再次植入，但只有69%的患者在1年后无感染且无需额外治疗。虽然THA中PJI的两阶段翻修术已被报道为成功，但关于该过程中并发症的报道很少。在我们的系列研究中，大量患者出现并发症，且通常发生在两期之间，突出了这种治疗方法的发病率。
