Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zurich, Switzerland.
Arch Orthop Trauma Surg. 2023 Jun;143(6):2823-2830. doi: 10.1007/s00402-022-04459-5. Epub 2022 May 4.
A preoperative pathogen detection is considered a prerequisite before undergoing one-stage exchange for prosthetic joint infection (PJI) according to most guidelines. This study compares patients with and without preoperative pathogen detection undergoing one-stage exchange for PJI of the hip. The authors put up the hypothesis that a preoperative pathogen detection is no prerequisite in selected cases undergoing one-stage exchange.
30 consecutive patients with PJI of the hip, treated with one-stage exchange, between 2011 and 2021, were retrospectively included. Mean age was 70 years and mean follow-up 2.1 ± 1.8 years. PJI was defined according to the European Bone and Joint Infection Society. One-stage exchange was performed in (1) chronic PJI longer than 4 weeks, (2) well-retained bone condition, (3) absence of multiple prior revisions for PJI (≤ 2) with absence of difficult-to-treat pathogens in the past, and (4) necessity/preference for early mobility due to comorbidities/age.
One-stage exchange was performed in 20 patients with and in 10 without a preoperative pathogen detection. Age (71 years, 68 years, p = 0.519), sex (50% and 30% males, p = 0.440), American Society of Anesthesiologists Score (2.2, 2.4, p = 0.502), and Charlson Comorbidity Index (3, 4, p = 0.530) did not differ among the two groups. No significant differences were noted concerning preoperative CRP (15 mg/l, 43 mg/l, p = 0.228), synovial cell count (15.990/nl, 5.308/nl, p = 0.887), radiological signs of loosening (55%, 50%, p = 0.999), and intraoperative histopathology. Except a higher rate of coagulase-negative staphylococci (70%, 20%, p = 0.019) in patients with a preoperative pathogen detection, no significant differences in pathogen spectrum were identified among groups. Revision for PJI recurrence was performed in one patient with an initial preoperative pathogen detection (3.3%). Additional revisions were performed for dislocation in two and postoperative hematoma in one patient. Revision rate for both septic and aseptic causes (p = 0.999), stay in hospital (16 and 15 days, p = 0.373) and modified Harris Hip Score (60, 71, p = 0.350) did not differ between groups.
Patients with and without a preoperative pathogen detection did not show significant differences concerning baseline characteristics, clinical and functional outcomes at 2 years. An absent preoperative pathogen detection is no absolute contraindication for one-stage exchange in chronic PJI, if involving good bone quality and absence of multiple prior revisions.
根据大多数指南，在进行一期关节置换术治疗假体关节感染（PJI）之前，术前病原体检测被认为是必要的。本研究比较了髋关节 PJI 一期置换术中进行和未进行术前病原体检测的患者。作者提出假设，在某些选定的病例中，术前病原体检测不是必需的。
回顾性纳入 2011 年至 2021 年期间接受髋关节 PJI 一期置换术的 30 例连续患者。平均年龄 70 岁，平均随访 2.1±1.8 年。PJI 根据欧洲骨与关节感染学会的标准定义。一期置换术适用于以下情况：（1）慢性 PJI 持续时间超过 4 周；（2）骨状况良好；（3）过去没有多次因 PJI 进行的翻修（≤2 次），且过去没有难以治疗的病原体；（4）由于合并症/年龄需要/偏好早期活动。
20 例患者进行了术前病原体检测，10 例患者未进行术前病原体检测。年龄（71 岁和 68 岁，p=0.519）、性别（50%和 30%男性，p=0.440）、美国麻醉师协会评分（2.2 和 2.4，p=0.502）和 Charlson 合并症指数（3 和 4，p=0.530）在两组之间无显著差异。两组患者术前 C 反应蛋白（15mg/L 和 43mg/L，p=0.228）、滑液细胞计数（15990/nl 和 5308/nl，p=0.887）、影像学松动迹象（55%和 50%，p=0.999）和术中组织病理学均无显著差异。除了术前病原体检测患者中凝固酶阴性葡萄球菌的发生率较高（70%和 20%，p=0.019）外，两组之间的病原体谱无显著差异。1 例有初始术前病原体检测的患者因 PJI 复发而进行了再次翻修（3.3%）。另外 2 例患者因脱位和 1 例患者因术后血肿而进行了再次翻修。两组因感染和非感染原因的翻修率（p=0.999）、住院时间（16 天和 15 天，p=0.373）和改良 Harris 髋关节评分（60 和 71，p=0.350）均无显著差异。
在基线特征、2 年临床和功能结果方面，有和没有术前病原体检测的患者之间没有显著差异。在涉及良好的骨质量和没有多次先前翻修的情况下，慢性 PJI 患者如果没有术前病原体检测，也不是一期置换术的绝对禁忌证。
