Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany.
Department of Surgery, Ruhr-University Hospital, Bochum, Hamburg, Germany.
Bone Joint J. 2021 Nov;103-B(11):1678-1685. doi: 10.1302/0301-620X.103B11.BJJ-2021-0022.R1.
One-stage revision hip arthroplasty for periprosthetic joint infection (PJI) has several advantages; however, resection of the proximal femur might be necessary to achieve higher success rates. We investigated the risk factors for resection and re-revisions, and assessed complications and subsequent re-revisions.
In this single-centre, case-control study, 57 patients who underwent one-stage revision arthroplasty for PJI of the hip and required resection of the proximal femur between 2009 and 2018 were identified. The control group consisted of 57 patients undergoing one-stage revision without bony resection. Logistic regression analysis was performed to identify any correlation with resection and the risk factors for re-revisions. Rates of all-causes re-revision, reinfection, and instability were compared between groups.
Patients who required resection of the proximal femur were found to have a higher all-cause re-revision rate (29.8% vs 10.5%; p = 0.018), largely due to reinfection (15.8% vs 0%; p = 0.003), and dislocation (8.8% vs 10.5%; p = 0.762), and showed higher rate of in-hospital wound haematoma requiring aspiration or evacuation (p = 0.013), and wound revision (p = 0.008). The use of of dual mobility components/constrained liner in the resection group was higher than that of controls (94.7% vs 36.8%; p < 0.001). The presence and removal of additional metal hardware (odds ratio (OR) = 7.2), a sinus tract (OR 4), ten years' time interval between primary implantation and index infection (OR 3.3), and previous hip revision (OR 1.4) increased the risk of proximal femoral resection. A sinus tract (OR 9.2) and postoperative dislocation (OR 281.4) were associated with increased risk of subsequent re-revisions.
Proximal femoral resection during one-stage revision hip arthroplasty for PJI may be required to reduce the risk of of recurrent or further infection. Patients with additional metalware needing removal or transcortical sinus tracts and chronic osteomyelitis are particularly at higher risk of needing proximal femoral excision. However, radical resection is associated with higher surgical complications and increased re-revision rates. The use of constrained acetabular liners and dual mobility components maintained an acceptable dislocation rate. These results, including identified risk factors, may aid in preoperative planning, patient consultation and consent, and intraoperative decision-making. Cite this article: 2021;103-B(11):1678-1685.
一期翻修髋关节置换术治疗假体周围关节感染（PJI）有几个优点；然而，为了获得更高的成功率，可能需要切除股骨近端。我们研究了切除和再翻修的危险因素，并评估了并发症和随后的再翻修。
在这项单中心病例对照研究中，我们确定了 2009 年至 2018 年间因髋关节 PJI 行一期翻修且需要切除股骨近端的 57 例患者。对照组由 57 例未行骨切除的一期翻修患者组成。采用逻辑回归分析确定与切除和再翻修的危险因素的任何相关性。比较两组之间的所有原因再翻修、再感染和不稳定的发生率。
我们发现需要切除股骨近端的患者的所有原因再翻修率较高（29.8%比 10.5%；p = 0.018），主要是由于再感染（15.8%比 0%；p = 0.003）和脱位（8.8%比 10.5%；p = 0.762），且住院期间血肿抽吸或引流（p = 0.013）和伤口翻修（p = 0.008）的发生率较高。切除组中使用双动组件/约束衬垫的比例高于对照组（94.7%比 36.8%；p < 0.001）。存在和去除其他金属硬件（比值比（OR）=7.2）、窦道（OR 4）、初次植入和感染指数之间的十年时间间隔（OR 3.3）以及既往髋关节翻修（OR 1.4）增加了股骨近端切除的风险。窦道（OR 9.2）和术后脱位（OR 281.4）与随后再翻修的风险增加相关。
在一期翻修髋关节置换术治疗 PJI 时，可能需要切除股骨近端以降低再次或进一步感染的风险。需要去除或经皮质窦道的额外金属固定物和慢性骨髓炎的患者发生股骨近端切除的风险更高。然而，根治性切除与更高的手术并发症和增加的再翻修率相关。约束髋臼衬垫和双动组件的使用保持了可接受的脱位率。这些结果（包括确定的危险因素）可能有助于术前规划、患者咨询和知情同意以及术中决策。引用本文：2021；103-B（11）：1678-1685。
