Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Speisinger Strasse 109, 1130, Vienna, Austria.
2nd Department, Orthopaedic Hospital Vienna-Speising, Speisinger Strasse 109, 1130, Vienna, Austria.
Arch Orthop Trauma Surg. 2023 Aug;143(8):4741-4754. doi: 10.1007/s00402-023-04770-9. Epub 2023 Jan 23.
Patients who require a spacer exchange as part of a two-stage procedure for the treatment of periprosthetic hip and knee joint infections (PJI) have high failure rates. Little is known about the clinical impact of microbiological results and changes in the microbiological spectrum and resistance pattern in these patients.
Between 01/2011 and 12/2019, 312 patients underwent a total of 327 two-stage revision arthroplasties at our institution. A spacer exchange was required in 52/312 (16.7%) patients (27 knee/25 hip). Microbiological results, antibiotic resistance patterns, patient's host factors as well as re-revision and re-infection rates at a median follow-up of 47.8 months (range 12.2-116.7 months) were analyzed. A propensity score (PS)-matched analysis of patients who underwent spacer exchange and patients treated with standard two-stage procedure was performed.
We found a high number of microbiological spectrum changes in patients with multiple culture positive procedures between explantations and spacer exchanges (10/12 [83.3%]), spacer exchanges and reimplantations (3/4 [75%]) as well as between reimplantations and subsequent re-revision surgeries (5/6 [83.3%]). In 9/52 (17.3%) patients, same microorganisms were detected repeatedly in two different procedures. We observed changes in the antibiotic resistance patterns in 6/9 (66.7%) of these patients. High re-infection rates were found in patients with culture positive reimplantations (10/12 [83.3%]), and low re-infection rates were found in patients with culture negative reimplantations (2/40 [5%]; p < 0.001). Between patients with and without spacer exchange, no differences were found in the re-revision rates (13/52 [25%] with vs. 13/52 [25%] without; p = 1.00) as well as re-infection rates (12/52 [23.1%] with vs. 8/52 [15.4%] without; p = 0.32).
Changes in microbiological spectrum and antibiotic resistance patterns between stages are common in patients who require a spacer exchange. If eradication of the microorganism at reimplantation can be accomplished, comparable re-revision rates to standard two-stage procedures can be achieved.
对于需要进行间隔器交换作为治疗人工关节周围髋关节和膝关节感染（PJI）两阶段手术的一部分的患者，其失败率很高。对于这些患者的微生物学结果以及微生物谱和耐药模式的变化对临床的影响知之甚少。
2011 年 1 月至 2019 年 12 月，我院共对 312 例患者进行了 327 例两阶段翻修关节成形术。52/312（16.7%）例患者（27 例膝关节/25 例髋关节）需要进行间隔器交换。分析了 52 例患者（间隔器交换）的微生物学结果、抗生素耐药模式、患者宿主因素以及在中位随访 47.8 个月（12.2-116.7 个月）时的再翻修和再感染率。对行间隔器交换的患者和行标准两阶段手术的患者进行了倾向评分（PS）匹配分析。
我们发现，在间隔器交换与取出假体之间、间隔器交换与再次植入之间（3/4[75%]）以及再次植入与随后的再次翻修手术之间（5/6[83.3%]），多次培养阳性手术的患者微生物谱变化的数量较多。在 9/52（17.3%）例患者中，在两个不同的手术中重复检测到相同的微生物。我们观察到其中 6/9（66.7%）例患者的抗生素耐药模式发生了变化。在培养阳性再次植入的患者中，发现了较高的再感染率（10/12[83.3%]），而在培养阴性再次植入的患者中，发现了较低的再感染率（2/40[5%]；p<0.001）。在行间隔器交换与不行间隔器交换的患者中，再翻修率（52 例中有 13 例[25%]行 vs. 52 例中无 13 例[25%]行；p=1.00）和再感染率（52 例中有 12 例[23.1%]行 vs. 52 例中无 8 例[15.4%]行；p=0.32）均无差异。
在需要进行间隔器交换的患者中，阶段之间的微生物谱和抗生素耐药模式的变化很常见。如果能在再次植入时消灭微生物，则可获得与标准两阶段手术相当的再翻修率。
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