Kildow Beau J, Springer Bryan D, Brown Timothy S, Lyden Elizabeth, Fehring Thomas K, Garvin Kevin L
Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Department of Orthopaedic Surgery, OrthoCarolina, Charlotte, NC 27707, USA.
J Clin Med. 2022 Mar 16;11(6):1657. doi: 10.3390/jcm11061657.
Two-stage exchange arthroplasty remains the gold standard in the United States for treatment of chronic periprosthetic joint infection (PJI). Long-term reinfection rates and clinical outcomes with sufficient subject numbers remain limited. The purpose was to evaluate the long-term outcomes following two-stage exchange following hip arthroplasty.
Retrospective review of 221 patients who underwent two-stage exchange hip arthroplasty for chronic PJI at three large tertiary referral institutions from 1990-2015. Outcomes including reinfection, mortality, and all-cause revision were calculated. Cumulative incidence of reinfection with death as competing factor was also calculated. Risk factors for reinfection were determined using Cox multivariate regression analysis.
Rate of infection eradication and all-cause revision was 88.24% and 22.6%, respectively. Overall mortality rate was 40.72%. Patients with minimum five-year follow-up ( = 129) had a success rate of 91.47% with mortality rate of 41.1%. Major risk factors for reinfection included polymicrobial infection (HR = 2.36, 95% CI: 1.08-5.14) and antibiotic resistant organism (HR = 2.36, 95% CI: 1.10-5.04).
This is the largest series with greater than 5-year follow-up evaluating outcomes of two-stage exchange hip arthroplasty. This technique resulted in a relatively high infection eradication, however, the mortality rate is alarmingly high. Antibiotic resistant organisms appear to be highest risk factor for failure.
在美国，两阶段翻修关节成形术仍是治疗慢性假体周围关节感染（PJI）的金标准。关于足够样本量的长期再感染率和临床结果的研究仍然有限。本研究旨在评估髋关节置换术后两阶段翻修的长期结果。
回顾性分析了1990年至2015年期间在三家大型三级转诊机构接受两阶段翻修髋关节置换术治疗慢性PJI的221例患者。计算了包括再感染、死亡率和全因翻修在内的结果。还计算了以死亡为竞争因素的再感染累积发生率。使用Cox多变量回归分析确定再感染的危险因素。
感染根除率和全因翻修率分别为88.24%和22.6%。总死亡率为40.72%。随访至少五年的患者（n = 129）成功率为91.47%，死亡率为41.1%。再感染的主要危险因素包括混合感染（HR = 2.36，95% CI：1.08 - 5.14）和抗生素耐药菌（HR = 2.36，95% CI：1.10 - 5.04）。
这是最大的一组随访超过5年的评估两阶段翻修髋关节置换术结果的系列研究。该技术导致相对较高的感染根除率，然而，死亡率高得惊人。抗生素耐药菌似乎是失败的最高风险因素。
