Sharma Rajeev K, Lumban-Gaol Imelda, Vinayak Udit, Budhiparama Nicolaas C
Institute of Orthopaedics & Joint Replacement, Moolchand Medcity, New Delhi, India.
Nicolaas Institute of Constructive Orthopaedic Research & Education Foundation for Arthroplasty & Sports Medicine at Medistra Hospital, Jakarta, Indonesia.
Arthroplast Today. 2025 Apr 24;33:101688. doi: 10.1016/j.artd.2025.101688. eCollection 2025 Jun.
This study aimed to evaluate the outcomes of debridement, antibiotics, and implant retention (DAIR) procedures and 2-stage revision surgeries in patients with periprosthetic joint infection following megaprosthesis, including treatment failure; the patient-reported outcomes; and to determine the survival rates of the revised megaprosthesis.
A retrospective study of 30 patients diagnosed with periprosthetic joint infection following megaprosthesis between 2018 and 2023, with minimum 1-year follow-up. Patients with previous unsuccessful debridement in other institutions were excluded. Patients presenting within 4 weeks of megaprosthesis implantation underwent the DAIR procedure, while those presenting after this window were taken for a 2-stage revision surgery. The primary outcome was treatment failure, defined as persistent wound complication or the need for subsequent surgical intervention. The secondary outcomes included patient-reported outcomes, assessed with the Oxford Hip Score and Oxford Knee Score, and the survival rates of the revised megaprosthesis.
The mean follow-up duration for all patients was 38 ± 12.6 months. Improvement was found for Oxford Hip Score and Oxford Knee Score with mean 34.22 ± 9.2 and 32.40 ± 8.1, respectively, at the 1-year follow-up. DAIR achieved an 81% success rate (13 out of 16) and 2-stage exchange had a 71.4% success rate (10 out of 14).
Both DAIR and 2-stage exchange procedures yielded favorable functional outcomes with satisfactory 2-year survival function. Careful patient selection and indication management are crucial for optimal results.
Level IV.
本研究旨在评估大假体周围关节感染患者行清创、抗生素及植入物保留（DAIR）手术和二期翻修手术的效果，包括治疗失败情况、患者报告结局，并确定翻修大假体的生存率。
对2018年至2023年间诊断为大假体周围关节感染的30例患者进行回顾性研究，随访时间至少1年。排除既往在其他机构清创失败的患者。大假体植入后4周内就诊的患者接受DAIR手术，而在此时间窗之后就诊的患者则接受二期翻修手术。主要结局为治疗失败，定义为持续的伤口并发症或需要后续手术干预。次要结局包括用牛津髋关节评分和牛津膝关节评分评估的患者报告结局，以及翻修大假体的生存率。
所有患者的平均随访时间为38±12.6个月。在1年随访时，牛津髋关节评分和牛津膝关节评分均有改善，平均分别为34.22±9.2和32.40±8.1。DAIR手术成功率为81%（16例中的13例），二期翻修手术成功率为71.4%（14例中的10例）。
DAIR手术和二期翻修手术均产生了良好的功能结局，2年生存功能令人满意。仔细的患者选择和适应证管理对于获得最佳结果至关重要。
四级。
