Caternicchia Filippo, Castagnini Francesco, Donati Danilo, Cavalieri Bruno, Masetti Claudio, Di Liddo Michele, Tella Giuseppe, Traina Francesco
Unità Operativa Ortopedia e Traumatologia, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy.
SC Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
Biomedicines. 2024 Oct 2;12(10):2247. doi: 10.3390/biomedicines12102247.
: Unexpected infections diagnosed after intraoperative cultures in aseptic revision hip arthroplasties are infrequent, but the features and outcomes of culture-positive cases are still poorly understood. A single-center retrospective study was conducted to assess the following: (1) the incidence, (2) the profile of the cases, and (3) the outcomes of the revision hips performed for presumed aseptic reasons that became septic after intraoperative cultures. Instances of first-time aseptic revision hips (a retrospective cohort study) in the hospital database were reviewed. The revisions with the isolation of two phenotypically identical microorganisms in the intraoperative cultures were selected. The profile (bacteria, pre-operative markers) and the outcomes of the revisions (survival rates, complications, reasons for re-revision) were assessed. Out of 424 cases of presumed aseptic revision hip arthroplasty, 19 patients (4.48%) were classified as septic. (9, 47.37%) was the most frequent microorganism. In three patients (15.8%), C-reactive protein and erythrocyte sedimentation rate values were higher, and in only one case (5.26%), C-reactive protein values and the white blood cell count were elevated. An antibiotic therapy was administered in every case. At a mean follow-up of 3.72 ± 2.18 years, three patients (15.79%) experienced complications (dislocation, pain without loosening, chronic suppressive antibiotic therapy) and two patients (10.53%) required re-revision for septic relapse (same microorganisms). The survival rate of the cohort was 89.47% (95% CI: 64.08-97.26) at 2 and 4 years. Missed periprosthetic infections rarely occurred in presumed aseptic revision hips. However, the outcomes are fair, and septic relapses are not uncommon.
无菌性髋关节翻修术中经术中培养诊断出的意外感染并不常见，但培养阳性病例的特征和结果仍知之甚少。进行了一项单中心回顾性研究以评估以下内容：（1）发病率，（2）病例概况，以及（3）因假定无菌原因进行翻修的髋关节在术中培养后发生感染的结果。回顾了医院数据库中首次无菌性髋关节翻修术的病例（一项回顾性队列研究）。选择术中培养分离出两种表型相同微生物的翻修病例。评估病例概况（细菌、术前指标）和翻修结果（生存率、并发症、再次翻修原因）。在424例假定无菌性髋关节翻修术中，19例患者（4.48%）被归类为感染性病例。（9例，47.37%）是最常见的微生物。3例患者（15.8%）的C反应蛋白和红细胞沉降率值较高，仅1例（5.26%）的C反应蛋白值和白细胞计数升高。所有病例均给予抗生素治疗。平均随访3.72±2.18年，3例患者（15.79%）出现并发症（脱位、无松动疼痛、慢性抑制性抗生素治疗），2例患者（10.53%）因感染复发（相同微生物）需要再次翻修。该队列在2年和4年时的生存率为89.47%（95%CI：64.08 - 97.₂6）。假定无菌性髋关节翻修术中假体周围感染漏诊很少发生。然而结果尚可，且感染复发并不罕见。
