Hadjimichael Argyris C, Foukas Athanasios F, Kaspiris Angelos, Vasileiou Dimitris, Kamariotis Spyros, Stylianakis Antonios, Vasiliadis Elias S, Savvidou Olga D, Antonopoulos Athanasios
Department of Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, W2 1NY, London, UK.
Third Department of Orthopaedic Surgery, "KAT" General Hospital of Athens, Nikis 2, 14561, Kifissia, Greece.
Infect Prev Pract. 2022 Jul 12;4(3):100232. doi: 10.1016/j.infpip.2022.100232. eCollection 2022 Sep.
Periprosthetic joint infection (PJI) is a devastating complication occurring in 1-2% of primary and up to 10% of revised total hip and knee arthroplasties (THA and TKA) impairing patient's quality of life. Occult infections are underdiagnosed, sub-treated and sub-clinically experienced by patients. This study aimed to correlate patients' clinical outcomes with early antibiotic treatment based on use or non-use of a sonication technique on explanted prostheses.
33 patients with revised THA or TKA were retrospectively evaluated. Clinical outcomes were assessed via Oxford hip or knee scores, and correlated with administration or not of antibiotic treatment based on sonication results.
According to laboratory findings the patients were divided in the following three groups: 1. Septic loosening (conventional cultures and/or sonication positive), 2. Aseptic loosening (conventional cultures and sonication negative) and 3. Occult loosening (conventional cultures negative, sonication not performed). The average Oxford score was poor (27.9/60) for the septic, excellent (43.8/60) for the aseptic and intermediate (37.7/60) for the occult group. Additionally, conventional cultures were negative, but sonication-positive, in 6 individuals with patient-related risk factors (male gender, BMI > 30 kg/m, diabetes, hypertension, steroids and rheumatoid arthritis).
Sonication represents a valuable diagnostic technique to guide administration of effective antibiotic treatment for patients, especially for detection of persistent post-revision occult infections. We recommend the systematic investigation of revised prostheses with a sonication technique, but especially in cases with risk factors for infection who it is suspected may have occult loosening.
人工关节周围感染（PJI）是一种严重的并发症，在初次全髋关节和膝关节置换术（THA和TKA）中发生率为1%-2%，在翻修手术中高达10%，会损害患者的生活质量。隐匿性感染诊断不足、治疗不充分，患者仅有亚临床症状。本研究旨在根据翻修假体是否使用超声处理技术进行早期抗生素治疗，探讨其与患者临床结局的相关性。
回顾性评估33例接受翻修THA或TKA的患者。通过牛津髋关节或膝关节评分评估临床结局，并根据超声处理结果与是否给予抗生素治疗进行相关性分析。
根据实验室检查结果，患者分为以下三组：1. 感染性松动（传统培养和/或超声检查阳性）；2. 无菌性松动（传统培养和超声检查阴性）；3. 隐匿性松动（传统培养阴性，未进行超声检查）。感染性松动组的牛津评分平均较差（27.9/60），无菌性松动组优秀（43.8/60），隐匿性松动组中等（37.7/60）。此外，6例有患者相关危险因素（男性、BMI>30kg/m²、糖尿病、高血压、使用类固醇和类风湿关节炎）的患者，传统培养为阴性，但超声检查为阳性。
超声检查是一种有价值的诊断技术，可指导对患者进行有效的抗生素治疗，特别是用于检测翻修术后持续存在的隐匿性感染。我们建议对翻修假体进行系统性的超声检查，尤其是对于疑似存在隐匿性松动的感染危险因素患者。
