Bourgonjen Yorrick P, Hooning van Duyvenbode J Fred F, van Dijk Bruce, Nurmohamed F Ruben H A, Veltman Ewout S, Vogely H Charles, van der Wal Bart C H
Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands.
J Bone Jt Infect. 2021 Oct 20;6(8):379-387. doi: 10.5194/jbji-6-379-2021. eCollection 2021.
: Two-stage revision surgery is the most frequently performed procedure in patients with a chronic periprosthetic joint infection (PJI). The infection eradication rates in the current literature differ between 54 % and 100 %, which could be attributed to different treatment strategies. The aim of this study was to retrospectively evaluate the infection eradication rate in patients with chronic PJI treated with two-stage revision surgery of the hip or knee in primary and re-revision cases. : All patients treated with a two-stage revision for chronic PJI between 2005 and 2011 were analysed. Patient and infection characteristics were retrieved. Primary outcome was successful infection eradication at last follow-up. Successful eradication is specified as no need for subsequent revision surgery or suppressive antibiotic treatment. : Forty-seven patients were treated with a two-stage revision. Infection eradication was achieved in 36 out of 47 cases. Thirty-eight patients had positive cultures: 35 monomicrobial infections and 3 polymicrobial infections. Nine cases of culture-negative infections were identified. Accompanying eradication rates were 26 out of 35 cases, 2 out of 3 cases, and 8 out of 9 cases respectively. Mean follow-up was 128 (27-186) months. For hip and knee revisions the eradication rates were 22 out of 31 cases and 14 out of 16 cases respectively. After primary arthroplasty the infection was eradicated in 29 out of 38 cases and after re-revision in 7 out of 9 cases. : In this study, the infection eradication rate for two-stage revision surgery after PJI of the hip and knee in primary and re-revision cases was 77 %. No statistically significant patient, infection and micro-organism characteristics were found which influence the infection eradication rates at long-term follow-up of 128 (27-186) months.
两阶段翻修手术是慢性人工关节周围感染（PJI）患者中最常施行的手术。当前文献中的感染根除率在54%至100%之间，这可能归因于不同的治疗策略。本研究的目的是回顾性评估初次及再次翻修病例中接受髋或膝关节两阶段翻修手术治疗的慢性PJI患者的感染根除率。
对2005年至2011年间接受两阶段翻修治疗慢性PJI的所有患者进行分析。收集患者和感染特征。主要结局是末次随访时成功根除感染。成功根除定义为无需后续翻修手术或抑制性抗生素治疗。
47例患者接受了两阶段翻修。47例中有36例实现了感染根除。38例患者培养结果为阳性：35例单一微生物感染和3例多微生物感染。确定了9例培养阴性感染。伴随的根除率分别为35例中的26例、3例中的2例和9例中的8例。平均随访时间为128（27 - 186）个月。对于髋关节和膝关节翻修，根除率分别为31例中的22例和16例中的14例。初次关节置换术后38例中有29例感染得到根除，再次翻修术后9例中有7例感染得到根除。
在本研究中，初次及再次翻修病例中髋和膝关节PJI后两阶段翻修手术的感染根除率为77%。在长达128（27 - 186）个月的长期随访中，未发现影响感染根除率的具有统计学意义的患者、感染及微生物特征。
