Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2695-2702. doi: 10.1007/s00590-023-03497-y. Epub 2023 Feb 27.
Extended trochanteric osteotomy (ETO) has proved to be an effective technique in complicated stem removal in femoral aseptic loosening or periprosthetic fracture. Debate remains about its safety in periprosthetic joint infection (PJI). The primary aim of this study is to analyze the ETO reinfection and union rate in two-stage hip revision.
A systematic literature review was performed regarding all studies reporting ETO outcomes in the two-stage revision for hip PJI up to October 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. A literature search was conducted in the following databases: MEDLINE/EMBASE, Scopus, Web of Science, and Cochrane. Quality assessment of the articles was performed using the Methodological Index for Non-Randomized Studies. This systematic review was registered in the International Prospective Registry of Systematic Reviews. Patient demographic, clinical, and surgical data were collected.
This systematic review included and analyzed nine clinical studies with a total of 382 ETO PJI hips in two-stage revision. The overall ETO reinfection rate was 8.9% (34 hips), consistent with the reinfection rate after two-stage revision in patients without ETO. The overall ETO union rate was 94.8% (347 hips), comparable to the ETO union rate in non-septic patients. Compared between a group of patients with ETO PJI and a group of patients with non-PJI ETO, there were no significant differences in postoperative complications, both septic and aseptic, and for postoperative HHS.
ETO proved to be a safe and effective procedure in PJI revisions. It may be a viable option in challenging femoral stem removal during the two-stage hip revision in PJI.
IV.
延长转子截骨术（ETO）已被证明是治疗股骨无菌性松动或假体周围骨折时复杂的假体取出的有效技术。但其在假体周围感染（PJI）中的安全性仍存在争议。本研究的主要目的是分析在二期髋关节翻修中，ETO 的再感染和愈合率。
根据系统评价和荟萃分析的首选报告项目标准，对截至 2022 年 10 月所有报告髋关节 PJI 二期翻修中 ETO 结果的研究进行了系统文献回顾。在以下数据库中进行了文献检索：MEDLINE/EMBASE、Scopus、Web of Science 和 Cochrane。使用非随机研究方法学指数对文章进行质量评估。本系统评价已在国际前瞻性系统评价注册库中注册。收集患者的人口统计学、临床和手术数据。
本系统评价纳入并分析了 9 项临床研究，共涉及 382 例二期翻修中 ETO 感染的 PJI 髋关节。总的 ETO 再感染率为 8.9%（34 髋），与未行 ETO 的二期翻修患者的再感染率一致。总的 ETO 愈合率为 94.8%（347 髋），与非感染患者的 ETO 愈合率相当。与 PJI 患者的 ETO 组和非 PJI 患者的 ETO 组相比，术后并发症（包括感染和非感染）和术后 HHS 无显著差异。
ETO 被证明是 PJI 翻修的一种安全有效的方法。在 PJI 二期髋关节翻修中，对于股骨假体取出困难的病例，ETO 可能是一种可行的选择。
IV。
