一期清创、抗生素保留假体与二期翻修治疗初次全膝关节置换术后 12 周内发生的假体周围关节感染的对比研究
A comparsion study between debridement, antibiotics, and implant retention and two-stage revision total knee arthroplasty for the management of periprosthetic joint infection occurring within 12 weeks from index total knee arthroplasty.
机构信息
Medical School of Chinese PLA, Beijing, 100853, China.
Department of Orthopedics, The First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100048, China.
出版信息
J Orthop Surg Res. 2022 Jun 27;17(1):330. doi: 10.1186/s13018-022-03218-x.
BACKGROUND
Managing periprosthetic joint infections are variable in practices. Debridement, antibiotics, and implant retention (DAIR) is one of the favorable interventions. Given that the success rate of the two-stage revision total knee arthroplasty (rTKA) might be overestimated. The purpose of this study is to compare the success rate between DAIR and standard two-stage rTKA with a comparable intervention time.
METHODS
We retrospectively reviewed the consecutive knee periprosthetic joint infection cases which underwent DAIR or two-stage rTKA (all procedures were performed by the senior author) within 12 weeks since their primary TKA between July 2009 and October 2019. Average follow-up was 72.20 ± 40.70 months (range 29-148 months) in the DAIR group compared to 89.14 ± 43.06 months after spacer insertion (range 29-163 months) in the two-stage revision group (P = 0.156). According to different interventions, demographic data; timing of surgical intervention; hospital for special surgery knee score; and success rate were collected and compared between the DAIR group and two-stage revision group. Failure of treatment was based on the Delphi consensus and the fate of spacers. The pathogen types and failure cases were also recorded and analyzed.
RESULTS
Average follow-up was 72.20 ± 40.70 months (range 29-148 months) in the DAIR group compared to 89.14 ± 43.06 months after spacer insertion (range 29-163 months) in the two-stage revision group. Time from index surgery was 3.90 ± 2.92 weeks (range 0-12 weeks) in the DAIR group, and 5.11 ± 2.86 weeks (range 0-12 weeks) in the 2-stage exchange group, respectively. The success rate was 70.0% and 75.0% in the DAIR group and two-stage revision group, respectively. But no significant differences were observed between the two groups.
CONCLUSION
DAIR demonstrated comparable effectiveness with two-stage rTKA. We recommended DAIR as a choice for patients with current infection within 12 weeks after primary TKA. For methicillin-resistant staphylococcal infections and fungal infections, two-stage rTKA might be preferred.
背景
在实践中，处理假体周围关节感染的方法各不相同。保留清创、抗生素和植入物（DAIR）是一种有利的干预措施。鉴于二期翻修全膝关节置换术（rTKA）的成功率可能被高估，本研究旨在比较 DAIR 与标准二期 rTKA 在可比干预时间内的成功率。
方法
我们回顾性分析了 2009 年 7 月至 2019 年 10 月期间，在初次 TKA 后 12 周内接受 DAIR 或二期 rTKA（所有手术均由资深作者完成）的连续膝关节假体周围关节感染病例。DAIR 组的平均随访时间为 72.20±40.70 个月（范围 29-148 个月），而二期翻修组在放置间隔器后为 89.14±43.06 个月（范围 29-163 个月）（P=0.156）。根据不同的干预措施，收集并比较了 DAIR 组和二期翻修组的人口统计学数据、手术干预时机、美国特种外科医院膝关节评分和成功率。治疗失败的依据是 Delphi 共识和间隔器的命运。还记录并分析了病原体类型和失败病例。
结果
DAIR 组的平均随访时间为 72.20±40.70 个月（范围 29-148 个月），而二期翻修组在放置间隔器后为 89.14±43.06 个月（范围 29-163 个月）。DAIR 组的手术时间为 3.90±2.92 周（范围 0-12 周），二期翻修组为 5.11±2.86 周（范围 0-12 周）。DAIR 组和二期翻修组的成功率分别为 70.0%和 75.0%，但两组间无显著差异。
结论
DAIR 与二期 rTKA 具有相当的疗效。我们建议将 DAIR 作为初次 TKA 后 12 周内发生当前感染患者的选择。对于耐甲氧西林金黄色葡萄球菌感染和真菌感染，可能更倾向于采用二期 rTKA。
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