Terhune E Bailey, Elmenawi Khaled A, Grimm Jessica A, Hannon Charles P, Bedard Nicholas A, Berbari Elie F, Berry Daniel J, Abdel Matthew P
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2025 Aug;40(8S1):S304-S309. doi: 10.1016/j.arth.2025.02.009. Epub 2025 Mar 23.
There is renewed interest in debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infections (PJIs). The purpose of this study was to assess the results of single DAIRs for acute PJI after primary hip arthroplasty in a large series with extended follow-up.
We identified 126 hips (108 total hip arthroplasties, 18 hemiarthroplasties) with acute PJIs treated with DAIR followed by chronic antibiotic suppression between 2000 and 2021 at a single institution. Acute postoperative PJI was defined as infection within four weeks of primary hip arthroplasty, and acute hematogenous PJI was defined as infection occurring more than four weeks after primary hip arthroplasty with symptoms for less than 21 days. The mean age was 67 years, 44% were women, and the mean body mass index was 34. Kaplan-Meier survivorship analyses were performed. The mean follow-up was seven years.
Survivorship free of reinfection was 80% at one year, 79% at two years, and 77% at five years. There was no difference in survivorship free of reinfection between early postoperative and acute hematogenous PJIs (P = 0.1). McPherson Host Grade C was predictive of reinfection (hazard ratio 5, P = 0.03). Reinfection was caused by the original organism in 33% of hips. The median time to reinfection was 13 days. Survivorship free of any revision was 82% at five years. Indications for revision included recurrent PJI (91%), dislocation (5%), and aseptic failures (5%).
In this large series of acute PJIs after primary hip arthroplasties treated with a single DAIR, infection-free survival was 77% at five years. Poor host status predicted reinfection. With a rigorous definition of acute PJI, success was markedly improved at extended follow-up compared to many historical series.
对于急性人工关节周围感染（PJI），清创、使用抗生素和保留植入物（DAIR）再次受到关注。本研究的目的是在一个进行了长期随访的大型队列中，评估初次髋关节置换术后急性PJI单次DAIR治疗的结果。
我们确定了2000年至2021年在单一机构接受DAIR治疗并随后进行慢性抗生素抑制治疗的126例急性PJI髋关节（108例全髋关节置换术，18例半髋关节置换术）。术后急性PJI定义为初次髋关节置换术后四周内发生的感染，急性血源性PJI定义为初次髋关节置换术后四周以上发生且症状持续少于21天的感染。平均年龄为67岁，44%为女性，平均体重指数为34。进行了Kaplan-Meier生存分析。平均随访时间为七年。
无再次感染的生存率在一年时为80%，两年时为79%，五年时为77%。术后早期和急性血源性PJI之间无再次感染生存率差异（P = 0.1）。McPherson宿主C级可预测再次感染（风险比5，P = 0.03）。33%的髋关节再次感染由原病原体引起。再次感染的中位时间为13天。五年时无任何翻修的生存率为82%。翻修的指征包括复发性PJI（91%）、脱位（5%）和无菌性失败（5%）。
在这一接受单次DAIR治疗的初次髋关节置换术后急性PJI的大型队列中，五年时无感染生存率为77%。宿主状态差可预测再次感染。通过对急性PJI的严格定义，与许多历史队列相比，长期随访时成功率显著提高。
