Villa Jesus M, Pannu Tejbir S, Braaksma William, Higuera Carlos A, Riesgo Aldo M
Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.
J Arthroplasty. 2023 Jan;38(1):141-145. doi: 10.1016/j.arth.2022.08.003. Epub 2022 Aug 8.
It is unknown whether extended oral antibiotic (EOA) prophylaxis reduces periprosthetic joint infection (PJI) rates after aseptic revision total hip (THA) and knee arthroplasty (TKA). The literature is scarce. Therefore, we sought to ascertain whether EOA prophylaxis decreases PJI rates after aseptic first-time revision THA and TKA when compared to standard prophylaxis.
This is a retrospective review of 328 consecutive revisions (3 surgeons, single institution, from September 27, 2017 to December 31, 2019). Preoperative 2013 Musculoskeletal Infection Society (MSIS) criteria, radiographs, and medications were reviewed. Inclusion criteria included aseptic first-time revision THA and TKA. Exclusion criteria were positive intraoperative cultures and/or histology, PJI (2013 MSIS criteria), hemiarthroplasty/partial arthroplasty revision, revision using foreign material (ie, mesh), metastatic bone disease, and intravenous antibiotics >24 hours after surgery. A total of 178 revisions were included, and 2 groups were set apart based on antibiotic prophylactic regime. The following were the groups: (1) EOA prophylaxis (>24 hours, n = 93) and (2) standard prophylaxis (≤24 hours, n = 85). Demographics, joint types, lengths of stay, skin-to-skin operative times, revision types, transfusions, discharge dispositions, and PJIs (per 2013 MSIS criteria) after the first-time revision were compared between groups. There were no significant differences in demographics. However, skin-to-skin operative time was significantly higher in the EOA group (123 minutes versus 98 minutes, P = .01). Mean follow-up was 849 days (range, 15-1,671). Statistical significance was set at a P value lower than .05.
Postoperative PJI rates were not significantly different: 2.2% EOA prophylaxis versus 3.5% standard prophylaxis (P = .671).
No significant difference was found between PJI rates between both prophylactic regimens. A large multicenter study with a larger sample size is needed to support EOA after aseptic revisions.
Level III.
对于无菌性全髋关节翻修术（THA）和膝关节置换术（TKA）后，延长口服抗生素（EOA）预防措施是否能降低假体周围关节感染（PJI）发生率尚不清楚。相关文献较少。因此，我们试图确定与标准预防措施相比，EOA预防措施能否降低无菌性初次翻修THA和TKA后的PJI发生率。
这是一项对328例连续翻修手术（3位外科医生，单一机构，时间从2017年9月27日至2019年12月31日）的回顾性研究。回顾了术前2013年肌肉骨骼感染学会（MSIS）的标准、X线片和用药情况。纳入标准包括无菌性初次翻修THA和TKA。排除标准为术中培养和/或组织学检查阳性、PJI（2013年MSIS标准）、半关节置换术/部分关节置换术翻修、使用异体材料（如网片）进行翻修、转移性骨病以及术后静脉使用抗生素超过24小时。共纳入178例翻修手术，并根据抗生素预防方案分为2组。分组如下：（1）EOA预防组（超过24小时，n = 93）和（2）标准预防组（≤24小时，n = 85）。比较两组初次翻修后的人口统计学数据、关节类型、住院时间、皮肤切开至皮肤缝合的手术时间、翻修类型、输血情况、出院处置以及PJI（根据2013年MSIS标准）。两组在人口统计学数据上无显著差异。然而，EOA组的皮肤切开至皮肤缝合手术时间显著更长（123分钟对98分钟，P = 0.01）。平均随访时间为849天（范围15 - 1671天）。统计学显著性设定为P值低于0.05。
术后PJI发生率无显著差异：EOA预防组为2.2%，标准预防组为3.5%（P = 0.671）。
两种预防方案的PJI发生率之间未发现显著差异。需要进行一项样本量更大的大型多中心研究来支持无菌性翻修术后的EOA预防措施。
三级。
