Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Orthop Surg. 2022 Jun;14(6):1175-1185. doi: 10.1111/os.13301. Epub 2022 May 18.
To compare the surgical outcomes of debridement, antibiotics, and single-stage total hip replacement (DASR) vs two-stage arthroplasty (two-stage arthroplasty) for chronic destructive septic hip arthritis (SHA).
Cases of chronic destructive SHA treated by DASR or two-stage arthroplasty in our department from January 2008 to October 2021 were retrospectively reviewed. Patient demographic information, perioperative inflammation markers, intraoperative blood loss, microbial culture, and metagenomic new generation sequencing results were recorded. The perioperative complications, hospital stay, hospitalization cost, infection recurrence rate, and Harris Hip Score (HHS) at the last follow-up were compared between the two groups.
A total of 28 patients were included in the study, including 11 patients who received DASR and 17 patients who received two-stage arthroplasty. There was no significant difference in demographic information, preoperative serum inflammatory markers, synovial fluid white blood cell count, or percentage of polymorphonuclear leukocytes between the two groups. The DASR group demonstrated significantly lower intraoperative blood loss [(368.2 ± 253.3) mL vs (638.2 ± 170.0) mL, p = 0.002], hospital stay [(22.6 ± 8.1) days vs (43.5 ± 13.2) days, p < 0.0001], and hospitalization expenses [(81,269 ± 11,496) RMB vs (137,524 ± 25,516) RMB, p < 0.0001] than the two-stage arthroplasty group. In the DASR group, one patient had dislocation as a complication. There were no cases with recurrence of infection. In the two-stage arthroplasty group, there was one case complicated with spacer fracture, one case with spacer dislocation, and one case with deep vein thrombosis of the lower limbs. There were no cases with recurrence of infection. There were no significant differences in the readmission rate, complication rate, or HHS at the last follow-up between the two groups.
Both DASR and two-stage arthroplasty achieved a satisfactory infection cure rate and functional recovery for chronic destructive SHA, and DASR demonstrated significantly lower intraoperative blood loss, hospital stay, and hospitalization costs than two-stage arthroplasty. For appropriately indicated patients, if microbial data are available and a standardized debridement protocol is strictly followed, DASR can be a treatment option.
比较清创术、抗生素和一期全髋关节置换术（DASR）与二期关节置换术（二期关节置换术）治疗慢性破坏性脓毒性髋关节关节炎（SHA）的手术效果。
回顾性分析 2008 年 1 月至 2021 年 10 月我科采用 DASR 或二期关节置换术治疗的慢性破坏性 SHA 病例。记录患者的人口统计学信息、围手术期炎症标志物、术中失血量、微生物培养和宏基因组新一代测序结果。比较两组围手术期并发症、住院时间、住院费用、感染复发率及末次随访时 Harris 髋关节评分（HHS）。
共纳入 28 例患者，其中 DASR 组 11 例，二期关节置换术组 17 例。两组患者的人口统计学信息、术前血清炎症标志物、滑膜液白细胞计数和多形核白细胞百分比无统计学差异。DASR 组术中出血量[（368.2±253.3）ml 比（638.2±170.0）ml，p=0.002]、住院时间[（22.6±8.1）d 比（43.5±13.2）d，p<0.0001]和住院费用[（81269±11496）元比（137524±25516）元，p<0.0001]均明显低于二期关节置换术组。DASR 组有 1 例发生脱位并发症，无感染复发病例。二期关节置换术组有 1 例发生间隔器骨折，1 例发生间隔器脱位，1 例发生下肢深静脉血栓形成，无感染复发病例。两组的再入院率、并发症发生率和末次随访时 HHS 无统计学差异。
DASR 和二期关节置换术均能获得满意的感染治愈率和慢性破坏性 SHA 功能恢复，DASR 组术中出血量、住院时间和住院费用明显低于二期关节置换术组。对于合适的患者，如果有微生物数据且严格遵循标准化清创方案，DASR 可以作为一种治疗选择。
