Ding Benjamin T K, D'Apolito Rocco, Sciamanna Lucia, Zagra Luigi
Dept of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore.
Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Bone Jt Open. 2025 Jun 1;6(6 Supple B):15-23. doi: 10.1302/2633-1462.66.BJO-2025-0004.R1.
This study aimed to verify the hypothesis that an antibiotic-loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA).
This was a retrospective, 1:1 matched cohort study of 238 patients, treated with cementless implants coated with and without DAC. A subgroup analysis was also conducted of patients undergoing second-stage revision THA for periprosthetic joint infection (PJI). Reinfection rates within two years, complications necessitating surgical intervention, and radiological analysis for aseptic loosening were assessed.
Overall, the mean age of the patients was 68.3 years (SD 11.5), with 39 (32.8%) McPherson class A, 64 (53.8%) class B, and 16 (13.4%) class C. Four (3.4%) patients in the DAC group developed complications including one PJI and one delayed wound healing, while 13 (10.9%) patients in the control group developed complications, including five PJIs and three delayed wound healing (p = 0.032). PJI rates (p = 0.136) and delayed wound healing rates (p = 0.337) were not statistically significant. For second-stage revision THA, for PJI there were 86 patients in the DAC group and 45 in the control group. One patient (1.2%) in the DAC group developed complications with no recurrences of infection or delayed wound healing, while ten patients (22.2%) in the control group developed complications including four recurrent PJI and one delayed wound healing (p = 0.003). Recurrent PJI rates were statistically significant (p = 0.005), while delayed wound healing rates were not (p = 0.165). Patients treated with DAC also had lower rates of aseptic loosening (0% compared with 6.7%; p = 0.015). No local or systemic side effects related to the DAC hydrogel coating were observed.
Antibiotic-impregnated hydrogel coatings on cementless implants appear to be associated with decreased complication rates after complex primary or revision THA. For second-stage revision THA for PJI, it is also associated with reduced risk of reinfection and aseptic loosening.
本研究旨在验证以下假设：在高危初次及翻修全髋关节置换术（THA）中使用载抗生素水凝胶——防御性抗菌涂层（DAC），可降低总体并发症和感染率。
这是一项回顾性1:1配对队列研究，纳入238例患者，分别接受有无DAC涂层的非骨水泥型植入物治疗。还对因假体周围关节感染（PJI）接受二期翻修THA的患者进行了亚组分析。评估了两年内的再感染率、需要手术干预的并发症以及无菌性松动的影像学分析。
总体而言，患者的平均年龄为68.3岁（标准差11.5），其中39例（32.8%）为麦克弗森A类，64例（53.8%）为B类，16例（13.4%）为C类。DAC组有4例（3.4%）患者出现并发症，包括1例PJI和1例伤口愈合延迟，而对照组有13例（10.9%）患者出现并发症，包括5例PJI和3例伤口愈合延迟（p = 0.032）。PJI发生率（p = 0.136）和伤口愈合延迟率（p = 0.337）无统计学意义。对于二期翻修THA，DAC组有86例PJI患者，对照组有45例。DAC组有1例患者（1.2%）出现并发症，无感染复发或伤口愈合延迟，而对照组有10例患者（22.2%）出现并发症，包括4例复发性PJI和1例伤口愈合延迟（p = 0.003）。复发性PJI发生率有统计学意义（p = 0.005），而伤口愈合延迟率无统计学意义（p = 0.165）。接受DAC治疗的患者无菌性松动率也较低（0%对比6.7%；p = 0.015）。未观察到与DAC水凝胶涂层相关的局部或全身副作用。
非骨水泥型植入物上的抗生素浸渍水凝胶涂层似乎与复杂初次或翻修THA后的并发症发生率降低有关。对于因PJI进行的二期翻修THA，它还与再感染和无菌性松动风险降低有关。
