Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
Arch Orthop Trauma Surg. 2023 Apr;143(4):1731-1740. doi: 10.1007/s00402-021-04330-z. Epub 2022 Jan 4.
Two-stage revision is a frequently chosen approach to treat chronic periprosthetic joint infection (PJI). However, management of recurrent infection after a two-stage exchange remains debated and the outcome of a repeat two-stage procedure is unclear. This study investigates the success rates of repeat two-stage exchange arthroplasty and analyzes possible risk factors for failure.
We retrospectively identified 55 patients (23 hips, 32 knees) who were treated with repeat resection arthroplasty and planned delayed reimplantation for recurrent periprosthetic joint infection between 2010 and 2019 after a prior two-stage revision at the same institution. The minimum follow-up was 12 months with a median follow-up time of 34 months (IQR 22-51). The infection-free survival, associated revision surgeries, and potential risk factors for further revision were analyzed using Kaplan-Meier survival curves and comparative non-parametric testing.
78% (43/55) underwent reimplantation after a repeat implant removal. Of those who completed the second-stage surgery, 37% (16/43) underwent additional revision for infection and 14% (6/55) underwent amputation. The reinfection-free implant survivorship amounted to 77% (95% CI 64-89%) after 1 year and 38% (95% CI 18-57%) after 5 years. Patients with a higher comorbidity score were less likely to undergo second-stage reimplantation (median 5 vs. 3, p = 0.034). Furthermore, obese patients (p = 0.026, Fisher's exact test) and diabetics (p < 0.001, log-rank test) had a higher risk for further infection. Most commonly cultures yielded polymicrobial growth at the repeat two-stage exchange (27%, 15/55) and at re-reinfection (32%, 9/28). Pathogen persistence was observed in 21% (6/28) of re-reinfected patients.
The success rates after repeat two-stage exchange arthroplasty are low. Patients must be counseled accordingly and different modes of treatment should be considered.
两阶段翻修是治疗慢性假体周围关节感染（PJI）的常用方法。然而，两阶段交换后复发性感染的处理仍存在争议，重复两阶段手术的结果尚不清楚。本研究调查了重复两阶段交换关节成形术的成功率，并分析了失败的可能危险因素。
我们回顾性地确定了 55 名患者（23 髋，32 膝），这些患者在同一机构接受了先前的两阶段翻修后，于 2010 年至 2019 年期间因假体周围关节感染复发而接受重复切除关节成形术和计划延迟再植入。最低随访时间为 12 个月，中位随访时间为 34 个月（IQR 22-51）。使用 Kaplan-Meier 生存曲线和非参数比较检验分析无感染生存、相关翻修手术和进一步翻修的潜在危险因素。
78%（43/55）在重复植入物取出后进行了再植入。在完成第二阶段手术的患者中，37%（16/43）因感染进行了额外的翻修，14%（6/55）进行了截肢。植入物无再感染的 1 年生存率为 77%（95%CI 64-89%），5 年生存率为 38%（95%CI 18-57%）。合并症评分较高的患者进行第二阶段再植入的可能性较低（中位数 5 分与 3 分，p=0.034）。此外，肥胖患者（p=0.026，Fisher 确切检验）和糖尿病患者（p<0.001，对数秩检验）再次感染的风险更高。最常见的是在重复两阶段交换时（27%，15/55）和再感染时（32%，9/28）培养出混合微生物生长。在 21%（6/28）再次感染的患者中观察到病原体持续存在。
重复两阶段交换关节成形术的成功率较低。必须相应地告知患者，应考虑不同的治疗方式。
