Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam.
International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
Eur J Orthop Surg Traumatol. 2023 Apr;33(3):645-651. doi: 10.1007/s00590-022-03317-9. Epub 2022 Jul 2.
Prosthetic joint infections (PJI) and especially tuberculosis (TB) PJI are rare diseases and hard to cure. The effectiveness of treatments for tuberculous PJI still remains a problem. The objective of this research was to indicate the success of two-stage revision replacement and also giving the associated criteria.
From 2015 to 2020, five patients with tuberculous PJI were treated with two-stage revision at Cho Ray hospital, Vietnam. We collected the dataset which included demographic data, the interval from the time of joint replacement to reported infection, records of tuberculous PJI, administration of anti-TB medications (duration, months), history of operation(s), duration of follow-up, and specific type(s) of antibiotics loaded in bone cement. The approval for this study was made by the institutional review board from Cho Ray Hospital, Vietnam. We conducted a literature review based on the keywords "PJI" and "TB" on PubMed.
Five patients [median age 66 years (range 35-84)] had found tuberculous PJI. The median time from arthroplasty to diagnosis was 19 months (range 4-48). The diagnosis was confirmed by joint aspirates or synovial tissue. Positive PCR was also reported in all cases. The average duration of anti-tuberculosis polytherapy administration was 14.4 months. The operative techniques on five patients included debridement and using spacer loaded with 2 g streptomycin (and 2 g vancomycin if they got a coinfection) for 1 pack of bone cement, and revision arthroplasty. In most cases, the outcome of treatment using two-stage revision replacement was 80%. Overall, the auxiliary bacterial infections were recognized in three patients with tuberculous PJI and Staphylococcus aureus. Streptomycin and vancomycin were loaded in a cement spacer to increase the success rate, and tuberculous PJI was controlled for all patients.
Tuberculous PJI can be controlled with two-stage revision replacement with an antibiotic-loaded cement spacer that is molded intraoperatively with custom mold and prolonged anti-tuberculosis treatment in all cases.
IV.
人工关节感染（PJI），尤其是结核性（TB）PJI，是罕见疾病且难以治愈。结核性 PJI 的治疗效果仍然是一个问题。本研究的目的是指出两阶段翻修置换的成功率，并给出相关标准。
2015 年至 2020 年，越南顺化医院对 5 例结核性 PJI 患者采用两阶段翻修治疗。我们收集了数据集，其中包括人口统计学数据、关节置换至报告感染的时间间隔、结核性 PJI 记录、抗结核药物（持续时间，月）的使用情况、手术史、随访时间以及骨水泥中加载的特定类型（种）抗生素。本研究经越南顺化医院机构审查委员会批准。我们基于 PubMed 上的“PJI”和“TB”关键词进行了文献回顾。
5 例患者[中位年龄 66 岁（范围 35-84 岁）]确诊为结核性 PJI。从关节置换到诊断的中位时间为 19 个月（范围 4-48）。通过关节抽吸或滑膜组织确认诊断。所有病例均报告了阳性 PCR。抗结核多药治疗的平均持续时间为 14.4 个月。5 例患者的手术技术包括清创术和使用载有 2 克链霉素（如果合并感染则载有 2 克万古霉素）的 1 包骨水泥作为间隔物，以及翻修关节置换术。在大多数情况下，两阶段翻修置换治疗的结果为 80%。总体而言，3 例结核性 PJI 和金黄色葡萄球菌患者合并辅助细菌感染。为了提高成功率，在水泥间隔物中加载链霉素和万古霉素，所有患者的结核性 PJI 均得到控制。
结核性 PJI 可以通过两阶段翻修置换治疗控制，术中使用定制模具成型的载抗生素水泥间隔物，并在所有病例中延长抗结核治疗。
IV 级。
