Department of Orthopedics, University Medical Center Utrecht, Utrecht.
Department of Medical Microbiology, University Medical Center Utrecht, Utrecht.
Acta Orthop. 2022 Jul 13;93:652-657. doi: 10.2340/17453674.2022.3975.
The long-term results of the 1- or 2-stage revision procedure and infection-free prosthesis survival in a tertiary referral center are unknown. In this retrospective observational study, the long-term results of infection control and infection-free prosthesis survival of the periprosthetic joint infection-related 1- and 2-stage revision procedure are evaluated. Furthermore, the merits of performing an antibiotic-free window in the 2-stage revision is evaluated.
All patients who received a 1- or 2-stage revision procedure of the hip or knee between 2010 and 2017 were included. Data was collected on patient and infection characteristics. The primary treatment aim was successful infection control without the use of antibiotic therapy afterwards. Infection-free survival analysis was performed using the Kaplan-Meier method with type of periprosthetic joint infection-related revision as covariate. Within the group of 2-stage revisions, use of an antibioticfree window was selected as covariate.
128 patients were treated for a periprosthetic joint infection-related revision procedure (81 hips and 47 knees). Successful infection control was achieved in 18 of 21 cases for the 1-stage and 89 out of 107 cases for the 2-stage revision procedure (83%) respectively after follow-up of more than 4 years. In addition, 2-stage revision procedure infection control was achieved in 52 of 60 cases with an antibiotic-free interval and 37 of 45 cases without such interval (p = 0.6). The mean infection-free survival of the 1-stage revision was 90 months (95% CI 75-105) and 98 months (CI 90-106) for the 2-stage revision procedure.
There seems to be no difference in infection control and infection-free survival between the 1- and 2-stage revision procedure. Second, an antibiotic-free window in the case of a 2-stage revision did not seem to influence treatment outcome. However, one must be cautious when interpreting these results due to confounding by indication and the small study population. Therefore, no definite conclusion can be drawn.
在三级转诊中心，1 期或 2 期翻修手术的长期结果以及无感染假体的存活率尚不清楚。在这项回顾性观察研究中，评估了髋关节或膝关节假体周围关节感染相关的 1 期和 2 期翻修手术中感染控制和无感染假体存活率的长期结果。此外，还评估了 2 期翻修中无抗生素窗口期的优点。
纳入 2010 年至 2017 年间接受髋关节或膝关节 1 期或 2 期翻修手术的所有患者。收集患者和感染特征的数据。主要治疗目标是成功控制感染，而无需随后使用抗生素治疗。使用 Kaplan-Meier 方法进行无感染生存分析，并将假体周围关节感染相关翻修的类型作为协变量。在 2 期翻修组中，选择使用无抗生素窗口作为协变量。
128 例患者因假体周围关节感染相关翻修手术接受治疗（81 髋，47 膝）。1 期翻修中 21 例中的 18 例（18/21，86%）和 2 期翻修中 107 例中的 89 例（83%）在随访 4 年以上后成功控制了感染。此外，52 例使用无抗生素间隔的 2 期翻修和 37 例未使用无抗生素间隔的 2 期翻修均成功控制了感染（p=0.6）。1 期翻修的无感染生存率为 90 个月（95%CI 75-105），2 期翻修的无感染生存率为 98 个月（CI 90-106）。
1 期和 2 期翻修在感染控制和无感染生存率方面似乎没有差异。其次，2 期翻修中无抗生素窗口似乎并不影响治疗结果。但是，由于存在混杂因素和研究人群较小，因此在解释这些结果时必须谨慎，因此无法得出明确的结论。
