Khnanisho Michael, Horne Carly, Deckey David G, Tarabichi Saad, Seyler Thorsten M, Bingham Joshua S
Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona; Albany Medical College, Albany, New York.
Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona; Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Knoxville, Tennessee.
J Arthroplasty. 2025 Aug;40(8):1945-1951.e2. doi: 10.1016/j.arth.2025.02.057. Epub 2025 Feb 25.
Although the two-stage exchange is the gold standard for the treatment of periprosthetic joint infection (PJI) in the United States, there is recent data to suggest that the utilization of a well-functioning destination spacer, also known as a "functional" or "1.5-stage revision," can be a viable treatment option in patients who have a PJI. The purpose of this systematic review was to evaluate the outcomes of patients undergoing a 1.5-stage revision for PJI and compare outcomes to a two-stage revision.
A systematic review was performed through PubMed, Scopus, and Embase databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed utilizing two reviewers. Following exclusions, 13 studies (n = 924 patients, 704 knees and 228 hips) were identified and included. A standardized template was utilized to capture demographic information (age, body mass index [BMI]), success/failure rate, mean follow-up time (years), and infection-free survivorship compared to two-stage revision. There were 556 patients (428 knees and 136 hips) who had 1.5-stage revisions included in the analyses. The mean age and body mass index were 65 years (range, 60 to 78) and 31 (range, 23.7 to 34.4), respectively.
At a mean follow-up time of 3.8 ± 1.1 years, the mean success rate was found to be 86.8%. The mean failure rate due to infection was 12.6%. In one study, infection-free survivorship was greater in the 1.5-stage revision cohort when compared to the two-stage revision cohort (94 versus 83%, P = 0.048). The remaining five studies that evaluated infection-free survivorship found no significant difference. However, there was a trend toward decreased the 90-day pain scores, postoperative complications, and cost in the 1.5-stage cohort.
Our systematic review demonstrated that a 1.5-stage revision is a viable and cost-effective treatment option for patients who have PJI. Infection-free survivorship was similar or greater when comparing a 1.5-stage revision to a two-stage revision. A 1.5-revision was associated with lower 90-day pain scores, postoperative complications, and decreased cost when compared to the two-stage revision in short-term follow-up, defined as less than five years. To better describe the procedure, we propose the name change to semipermanent eluting antibiotic revision procedure.
IV.
尽管两阶段翻修术是美国治疗假体周围关节感染（PJI）的金标准，但最近有数据表明，使用功能良好的占位间隔物（也称为“功能性”或“1.5阶段翻修”）对于患有PJI的患者可能是一种可行的治疗选择。本系统评价的目的是评估接受1.5阶段PJI翻修术患者的结局，并将结局与两阶段翻修术进行比较。
通过PubMed、Scopus和Embase数据库进行系统评价。由两名评价者遵循系统评价和Meta分析的首选报告项目2020指南。排除后，确定并纳入了13项研究（n = 924例患者，704例膝关节和228例髋关节）。使用标准化模板获取人口统计学信息（年龄、体重指数[BMI]）、成功/失败率、平均随访时间（年）以及与两阶段翻修术相比的无感染生存率。分析中纳入了556例接受1.5阶段翻修术的患者。平均年龄和体重指数分别为65岁（范围60至78岁）和31（范围23.7至34.4）。
在平均随访时间3.8±1.1年时，平均成功率为86.8%。因感染导致的平均失败率为12.6%。在一项研究中，与两阶段翻修术队列相比，1.5阶段翻修术队列的无感染生存率更高（94%对83%，P = 0.048）。其余五项评估无感染生存率的研究未发现显著差异。然而，1.5阶段队列在90天疼痛评分、术后并发症和费用方面有下降趋势。
我们的系统评价表明，1.5阶段翻修术对于患有PJI的患者是一种可行且具有成本效益的治疗选择。将1.5阶段翻修术与两阶段翻修术相比，无感染生存率相似或更高。在短期随访（定义为少于五年）中，与两阶段翻修术相比，1.5阶段翻修术与更低的90天疼痛评分、术后并发症和更低的费用相关。为了更好地描述该手术，我们建议将名称更改为半永久性洗脱抗生素翻修手术。
IV级。
