Jarusriwanna Atthakorn, Mu Wenbo, Parvizi Javad
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand.
J Clin Med. 2024 Aug 16;13(16):4848. doi: 10.3390/jcm13164848.
Local antibiotic infusion has emerged as a promising adjunctive therapy, delivering high concentrations of antibiotics directly to the infection site. This approach aims to enhance eradication of pathogens while minimizing systemic side effects associated with prolonged antibiotic use. This narrative review encompassed 10 articles focused on all three procedures of surgical intervention for periprosthetic joint injection (PJI) following total hip arthroplasty (THA): debridement, antibiotics, and implant retention (DAIR), single-stage revision arthroplasty, and two-stage revision arthroplasty. Recent studies report success rates ranging from 90 to 100% in patients undergoing DAIR, 82 to 100% in single-stage revision arthroplasty, and 80% in two-stage revision arthroplasty. The adjunctive use of local antibiotic infusion alongside surgical treatment for PJI following THA provides high success rates and is associated with low systemic complications, such as renal toxicity. Further research, particularly high-quality randomized controlled trials (RCTs), is warranted to validate and refine treatment protocols, ensuring consistent efficacy and safety.
局部抗生素灌注已成为一种有前景的辅助治疗方法，可将高浓度抗生素直接输送到感染部位。这种方法旨在提高病原体清除率，同时将与长期使用抗生素相关的全身副作用降至最低。本叙述性综述涵盖了10篇文章，这些文章聚焦于全髋关节置换术（THA）后假体周围关节感染（PJI）的三种手术干预程序：清创、抗生素和植入物保留（DAIR）、一期翻修关节成形术和二期翻修关节成形术。近期研究报告称，接受DAIR治疗的患者成功率在90%至100%之间，一期翻修关节成形术的成功率在82%至100%之间，二期翻修关节成形术的成功率为80%。THA后PJI的手术治疗联合局部抗生素灌注具有较高的成功率，且全身并发症（如肾毒性）发生率较低。有必要进行进一步研究，尤其是高质量的随机对照试验（RCT），以验证和完善治疗方案，确保疗效和安全性的一致性。
