Sutton Ryan, Lizcano Juan D, Fraval Andrew, Wiafe Bright, Courtney P Maxwell, Brown Scot
From Rothman Orthopaedic Institute, Philadelphia, PA.
J Am Acad Orthop Surg. 2024 Dec 15;32(24):e1308-e1314. doi: 10.5435/JAAOS-D-24-00013. Epub 2024 May 29.
Although two-stage exchange has been the standard of care for periprosthetic joint infection (PJI) in the United States, single-stage exchange is emerging as an option in select patients. The purpose of this study was to compare outcomes of patients undergoing single-stage and two-stage exchange using strict surgical indications.
We reviewed a consecutive series of 196 patients with diagnosed PJI undergoing revision total knee and hip arthroplasty from 2017 to 2021. Patients were excluded if they had PJI history, plastic surgery coverage, or extensive bone loss requiring endoprosthesis. We compared the number of patients PJI-free at 1-year follow-up using MusculoSkeletal Infection Society criteria and patients requiring re-revision between the single-stage and two-stage groups.
In total, 126 patients met inclusion criteria. Of 61 knee patients (48.4%), 22 underwent single-stage (36%) and 39 underwent two-stage (63.9%). Of 65 hip patients (51.6%), 38 underwent single-stage (58.5%) and 27 underwent two-stage (41.5%). At a mean follow-up of 1.95 ± 0.88 years, a higher rate of knee patients were classified as having treatment success in the single-stage group (77.3% versus 69.2%, P = 0.501), however with comparable septic failure rates (18.1% single-stage versus 17.9% two-stage; P = 0.982). At a mean follow-up of 1.81 ± 0.9 years, a higher rate of hip patients were classified as having treatment success in the single-stage group (94.7% versus 81.5%, P = 0.089), and more patients had septic failures in the two-stage group (18.5% versus 5.3%; P = 0.089). No differences were observed in the microorganism profile. More total complications ( P = 0.021) and mortalities were found in the single-stage knee cohort than in the two-stage cohort (22.7% versus 2.6%; P = 0.011).
Single-stage arthroplasty is a viable alternative to standard two-stage exchange in patients with PJI without a history of infection and with no bone or soft-tissue compromise. Additional studies with longer term follow-up are needed to evaluate its efficacy.
在美国，虽然两阶段翻修一直是治疗人工关节周围感染（PJI）的标准方法，但单阶段翻修正逐渐成为特定患者的一种选择。本研究的目的是使用严格的手术指征比较接受单阶段和两阶段翻修患者的治疗结果。
我们回顾了2017年至2021年连续收治的196例诊断为PJI并接受全膝关节和髋关节置换翻修术的患者。如果患者有PJI病史、接受过整形手术或因广泛骨丢失需要植入假体，则将其排除。我们使用肌肉骨骼感染学会的标准比较了单阶段和两阶段组中1年随访时无PJI的患者数量以及需要再次翻修的患者数量。
共有126例患者符合纳入标准。在61例膝关节患者（48.4%）中，22例接受单阶段翻修（36%），39例接受两阶段翻修（63.9%）。在65例髋关节患者（51.6%）中，38例接受单阶段翻修（58.5%），27例接受两阶段翻修（41.5%）。平均随访1.95±0.88年时，单阶段组膝关节患者治疗成功的比例更高（77.3%对69.2%，P = 0.501），但败血症失败率相当（单阶段组为18.1%，两阶段组为17.9%；P = 0.982）。平均随访1.81±0.9年时，单阶段组髋关节患者治疗成功的比例更高（94.7%对81.5%，P = 0.089），两阶段组败血症失败的患者更多（18.5%对5.3%；P = 0.089）。微生物谱无差异。单阶段膝关节队列中的总并发症（P = 0.021）和死亡率高于两阶段队列（22.7%对2.6%；P = 0.011）。
对于无感染史且无骨或软组织受损的PJI患者，单阶段关节置换术是标准两阶段翻修的可行替代方案。需要进行更长时间随访的进一步研究来评估其疗效。
