LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
J Arthroplasty. 2023 Jul;38(7S):S235-S241. doi: 10.1016/j.arth.2023.02.072. Epub 2023 Mar 5.
Management of periprosthetic joint infection after total hip arthroplasty (THA) has traditionally consisted of a 2-stage approach. However, 1.5-stage exchange has garnered recent interest. We compared 1.5-stage to 2-stage exchange recipients. Specifically, we assessed (1) infection-free survivorship and risk factors for reinfection; (2) 2-year surgical/medical outcomes (eg, reoperations, readmissions); (3) Hip Disability and Osteoarthritis Outcome Scores for Joint Replacement (HOOS-JR); and (4) radiographic outcomes (ie, progressive radiolucent lines, subsidences, and failures).
We reviewed a consecutive series of 1.5-stage or planned 2-stage THAs. A total of 123 hips were included (1.5-stage: n = 54; 2-stage: n = 69) with mean clinical follow-up of 2.5 years (up to 8 years). Bivariate analyses assessed incidences of medical and surgical outcomes. Additionally, HOOS-JR scores and radiographs were evaluated.
The 1.5-stage exchange had 11% greater infection-free survivorship at final follow-up compared to 2 stages (94% versus 83%, P = .048). Morbid obesity was the only independent risk factor demonstrating increased reinfection among both cohorts. No differences in surgical/medical outcomes were observed between groups (P = .730). HOOS-JR scores improved markedly for both cohorts (1.5-stage difference = 44.3, 2-stage difference = 32.5; P < .001). A total of 82% of 1.5-stage patients did not demonstrate progressive femoral or acetabular radiolucencies, while 94% of 2-stage recipients did not have femoral radiolucencies and 90% did not have acetabular radiolucencies.
The 1.5-stage exchange appeared to be an acceptable treatment alternative for periprosthetic joint infections after THAs with noninferior infection eradication. Therefore, this procedure should be considered by joint surgeons for treatment of periprosthetic hip infections.
传统上，全髋关节置换术后（THA）假体周围关节感染的治疗方法包括两阶段法。然而，1.5 阶段置换已引起人们的关注。我们比较了 1.5 阶段和 2 阶段置换患者。具体而言，我们评估了：（1）无感染生存率和再感染的危险因素；（2）2 年的手术/医疗结果（例如，再次手术，再入院）；（3）髋关节残疾和骨关节炎结果评分（HOOS-JR）；（4）影像学结果（即，进行性透亮线，下沉和失败）。
我们回顾了一系列连续的 1.5 阶段或计划的 2 阶段 THA。共纳入 123 髋（1.5 阶段：n=54；2 阶段：n=69），平均临床随访时间为 2.5 年（最长 8 年）。采用双变量分析评估了医疗和手术结果的发生率。此外，还评估了 HOOS-JR 评分和 X 光片。
与 2 阶段相比，1.5 阶段置换的无感染生存率在最终随访时高 11％（94％比 83％，P=.048）。病态肥胖是两个队列中唯一显示增加再感染的独立危险因素。两组之间的手术/医疗结果无差异（P=.730）。两个队列的 HOOS-JR 评分均明显提高（1.5 阶段差异= 44.3，2 阶段差异= 32.5；P <.001）。1.5 阶段患者中有 82％的患者未出现股骨或髋臼进行性透亮线，而 2 阶段患者中有 94％的患者未出现股骨透亮线，90％的患者未出现髋臼透亮线。
1.5 阶段置换术似乎是 THA 后假体周围关节感染的一种可接受的治疗选择，其感染消除效果不劣于传统方法。因此，关节外科医生应考虑将该手术作为治疗髋关节假体周围感染的方法。
