Vles Georges, Bossen Jeroen, Kloos Johannes, Debeer Philippe, Ghijselings Stijn
Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopaedic Research and Training (IORT), Leuven, KU, Belgium.
Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
J Exp Orthop. 2022 Mar 21;9(1):28. doi: 10.1186/s40634-022-00467-x.
A septic revision of an artificial joint is routinely split up in a so-called dirty phase and a clean phase. The measures taken to initiate the start of the clean phase vary significantly between musculoskeletal infection centers. We performed simulations of one-step exchanges of infected THAs and sought to 1) determine the effect of different clean phase protocols on the sterile field, and 2) determine whether or not it is possible to re-implant the new prosthesis completely clean.
Nine fresh frozen cadaveric hips were used and primary THA was undertaken via a direct anterior approach. Before implantation of the components varying amounts of fluorescent powder (GloGerm) were deposited, simulating bacterial infection. Second, a one-step exchange was performed via a posterolateral approach. After implant removal, debridement, and lavage, randomization determined which clean phase protocol was followed, i.e. no, some or full additional measures. Finally, the new prosthesis was re-implanted. In order to determine the effect of different clean phase protocols on contamination of the sterile field standardized UV light-enhanced photographs were obtained of 1) the gloves, 2) the instrument table, 3) the drapes, and 4) the wound and these were ranked on cleanliness by a blinded panel of hip surgeons. In order to determine whether or not it is possible to re-implant the prosthesis completely clean, the implant was taken out again at the end of the one-step exchange and inspected for contamination under UV light.
The gloves, the instrument table, the drapes and the wound were significantly cleaner after a clean phase using full additional measures compared to partial or no additional measures (p < 0.000). Partial measures were able to reduce some of the contamination of the gloves and the wound, but had no effect on the drapes and the instrument table. All re-implanted implants were contaminated with some amount of fluorescent powder at the end of the one-step exchange.
We advise to incorporate a clean phase with full additional measures into the surgical treatment of prosthetic joint infections, as partial measures seem to be a poor compromise.
Not applicable (cadaveric study).
人工关节的感染性翻修通常分为所谓的污染期和清洁期。在不同的肌肉骨骼感染中心，启动清洁期所采取的措施差异很大。我们对感染性全髋关节置换术（THA）的一步置换进行了模拟，并试图：1）确定不同清洁期方案对无菌区域的影响；2）确定是否有可能将新假体完全清洁后重新植入。
使用九个新鲜冷冻的尸体髋关节，通过直接前路进行初次THA。在植入组件之前，沉积不同量的荧光粉（GloGerm），模拟细菌感染。其次，通过后外侧入路进行一步置换。取出植入物、清创和冲洗后，通过随机分组确定采用哪种清洁期方案，即不采取、采取部分或全部额外措施。最后，重新植入新假体。为了确定不同清洁期方案对无菌区域污染的影响，对以下部位拍摄了标准化的紫外线增强照片：1）手套；2）器械台；3）手术巾；4）伤口，并由一组不知情的髋关节外科医生根据清洁程度进行排名。为了确定是否有可能将假体完全清洁后重新植入，在一步置换结束时再次取出植入物，并在紫外线下检查是否有污染。
与采取部分或不采取额外措施相比，在采用全部额外措施的清洁期后，手套、器械台、手术巾和伤口明显更清洁（p < 0.000）。部分措施能够减少手套和伤口上的一些污染，但对手术巾和器械台没有影响。在一步置换结束时，所有重新植入的植入物都被一定量的荧光粉污染。
我们建议在人工关节感染的外科治疗中纳入采用全部额外措施的清洁期，因为部分措施似乎是一种欠佳的折衷办法。
不适用（尸体研究）。
