Centre for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany.
J Int Med Res. 2021 Sep;49(9):3000605211028123. doi: 10.1177/03000605211028123.
To examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome.
This retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded.
A total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0-91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with received antibiotic treatment and did not develop PJI. Another patient with growth of that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA.
Sonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.
探讨髋关节骨折固定后疑似无菌性转换全髋关节置换术（THA）的超声结果，并评估其对治疗结果的影响。
本回顾性队列研究回顾了 2012 年至 2018 年间疑似无菌患者行股骨近端骨折内固定物转换为 THA 的资料。使用骨合成材料和组织样本的超声对微生物进行分析。记录治疗结果，包括假体周围关节感染（PJI）的发生情况。
共有 32 例患者纳入研究。其中，5 例（15.6%）患者术中培养阳性。转换 THA 后的平均随访时间为 43.0 个月（范围，19.0-91.5 个月）。超声检查结果阳性 3 例（9.4%），均为污染，未发生 PJI。2 例（6.3%）组织培养阳性。1 例患者接受抗生素治疗，未发生 PJI。另 1 例患者最初被分类为污染的 生长，后来发展为同一病原体引起的急性 PJI。总体而言，转换 THA 后有 2 例（6.3%）患者发生 PJI。
在临床无菌性转换 THA 中，固定装置的超声检查并未增加诊断价值。需要进一步研究以更好地了解意外阳性培养的相关性，并制定这些患者管理的诊断标准。
