Akgün Doruk, Wiethölter Mats, Maziak Nina, Paksoy Alp, Karczewski Daniel, Scheibel Markus, Moroder Philipp
Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlind, Charitéplatz 1, 10117 Berlin, Germany.
J Clin Med. 2021 Nov 6;10(21):5186. doi: 10.3390/jcm10215186.
Patients with a periprosthetic joint infection (PJI) of the shoulder, who fail to undergo reimplantation in an attempted two-stage exchange seem to be neglected in the current literature. The aim of this study was to assess the clinical course of patients after the first stage in the process of an attempted two-stage exchange for shoulder PJI.
After a retrospective review of our institutional database between 2008 and 2018, 49 patients, who were treated with an intended two-stage exchange for shoulder PJI, were identified. Patients' demographics, laboratory and health status parameters, along with records of clinical outcome were collected. The primary outcome measurements analyzed were infection eradication, successful reimplantation, and patient survival.
Reimplantation was completed in only 35 (71%) of 49 cases and eradication of infection was achieved in 85.7% of patients with successful reimplantation after a mean follow-up duration of 5.1 years (1.1 to 10.2 years). Reasons for failure to reimplant were premature death in 36%, high general morbidity in 29%, satisfaction with the current status in 21%, or severe infection with poor bone and soft tissues in 14% of the patients. Of the 14 cases without reimplantation, eradication rate of infection was 57% after a mean follow-up of 5 years (2.6 to 11 years). The overall mortality rate of the entire cohort was 25% at the latest follow-up and 10% within ninety days after implant removal. Patients who deceased or did not undergo reimplantation during the follow-up were significantly older and had a significantly higher Charlson comorbidity index (CCI).
While the two-stage exchange arthroplasty can lead to high rates of infection eradication, a considerable subset of patients never undergoes the second stage for a variety of reasons. Shoulder PJI and its treatment are associated with a high risk of mortality, especially in patients with older age and higher CCI.
对于肩部假体周围关节感染（PJI）患者，在尝试进行两阶段置换时未能进行再植入的情况，在当前文献中似乎被忽视了。本研究的目的是评估在尝试对肩部PJI进行两阶段置换过程中第一阶段后患者的临床病程。
在对我们机构2008年至2018年的数据库进行回顾性分析后，确定了49例接受肩部PJI两阶段置换治疗的患者。收集了患者的人口统计学、实验室和健康状况参数以及临床结果记录。分析的主要结局指标为感染根除、成功再植入和患者存活情况。
49例患者中仅35例（71%）完成了再植入，平均随访5.1年（1.1至10.2年）后，成功再植入的患者中有85.7%实现了感染根除。未进行再植入的原因包括36%的患者过早死亡、29%的患者全身发病率高、21%的患者对现状满意以及14%的患者存在严重感染且骨和软组织状况不佳。在14例未进行再植入的患者中（平均随访5年，2.6至11年），感染根除率为57%。在最新随访时，整个队列的总死亡率为25%，在植入物取出后90天内为10%。在随访期间死亡或未进行再植入的患者年龄显著更大，且Charlson合并症指数（CCI）显著更高。
虽然两阶段置换关节成形术可导致较高的感染根除率，但相当一部分患者由于各种原因从未进行第二阶段手术。肩部PJI及其治疗与高死亡率风险相关，尤其是在年龄较大和CCI较高的患者中。
