Owen Aaron R, Dilger Oliver B, Bedard Nicholas A, Hannon Charles P, Mabry Tad M, Berry Daniel J, Abdel Matthew P
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2025 Aug;40(8S1):S310-S316. doi: 10.1016/j.arth.2025.02.006. Epub 2025 Feb 14.
A two-stage exchange arthroplasty is the standard management method of chronic periprosthetic joint infections (PJIs) of the hip in North America. However, a subset of patients become reinfected and may require a repeat two-stage exchange arthroplasty. The purpose of the present study was to assess revisions, reoperations, and risk factors for failure associated with repeat two-stage exchange arthroplasties for recurrent PJIs after total hip arthroplasty (THA).
We identified 52 repeat two-stage exchange THAs completed from 2000 to 2021 at a single, high-volume academic medical center. The mean age was 61 years, 39% were women, and the mean body mass index was 33. At the time of the repeat two-stage exchange, high-dose antibiotic spacers were used in 90% of patients (28 articulating, 19 nonarticulating), and 10% had a resection arthroplasty in the interim between stages. The mean time from repeat first stage to reimplantation was 33 weeks. At the final follow-up, 54% of patients were on chronic antibiotic therapy. The mean follow-up was 6 years.
The 7-year survivorships free of re-revision for reinfection, any re-revision, and any reoperation were 85, 57, and 50%, respectively. The leading indications for re-revision were dislocation (45%) and PJI (35%). McPherson host grade C was a significant risk factor for re-revision for infection (HR [hazard ratio] 5, P = 0.04). Additionally, increased operative time at reimplantation was a risk for any reoperation (HR 1.06, P < 0.01) and reoperation for infection (HR 1.07, P < 0.01). At the final follow-up, 98% of patients had a revision THA in situ (one hip disarticulation).
Repeat two-stage exchange arthroplasty of the hip had a 7-year survivorship free of re-revision for infection that was 85%, but only 57% were free of any re-revision (most due to revision for dislocation). McPherson C hosts had a 5-fold increased risk of reinfection.
Level IV.
两阶段翻修关节成形术是北美髋部慢性人工关节周围感染（PJI）的标准治疗方法。然而，一部分患者会再次感染，可能需要再次进行两阶段翻修关节成形术。本研究的目的是评估全髋关节置换术（THA）后复发性PJI的重复两阶段翻修关节成形术相关的翻修、再次手术以及失败的危险因素。
我们确定了2000年至2021年在一家大型学术医疗中心完成的52例重复两阶段翻修THA。平均年龄为61岁，39%为女性，平均体重指数为33。在重复两阶段翻修时，90%的患者使用了高剂量抗生素间隔物（28个可活动的，19个不可活动的），10%的患者在两阶段之间进行了关节切除成形术。从重复第一阶段到再次植入的平均时间为33周。在最后一次随访时，54%的患者接受慢性抗生素治疗。平均随访时间为6年。
无再次翻修以治疗再感染、任何再次翻修和任何再次手术的7年生存率分别为85%、57%和50%。再次翻修的主要指征是脱位（45%）和PJI（35%）。麦克弗森宿主C级是感染再次翻修的显著危险因素（风险比[HR]5，P = 0.04）。此外，再次植入时手术时间延长是任何再次手术（HR 1.06，P < 0.01）和因感染再次手术（HR 1.07，P < 0.01）的危险因素。在最后一次随访时，98%的患者原位进行了翻修THA（一例髋关节离断）。
髋部重复两阶段翻修关节成形术无再次翻修以治疗感染的7年生存率为85%，但只有57%的患者无任何再次翻修（大多数是因脱位翻修）。麦克弗森C级宿主再感染风险增加5倍。
IV级。
