Goh Graham S, Neumann Markus, Salber Jochen, Gehrke Thorsten, Citak Mustafa
Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany; Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts.
Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
J Arthroplasty. 2025 Jun 17. doi: 10.1016/j.arth.2025.06.048.
Most surgeons traditionally recommend a two-stage exchange for patients who have polymicrobial periprosthetic joint infections (PJIs) because of the opportunity to obtain cultures. Consequently, outcome data on the one-stage strategy in this distinct population remains extremely limited. Given the renewed interest in one-stage revision, this study aimed to evaluate the mean 5-year results of patients who underwent one-stage revision THA for polymicrobial PJI.
Patients who had polymicrobial PJI and who underwent one-stage revision THA between 2016 and 2022 were retrospectively reviewed using an institutional joint registry. A PJI was defined using the 2018 International Consensus Meeting criteria. In total, 65 patients had positive cultures isolating two or more distinct microorganisms. The mean age was 60 years, and 66% were women. The primary endpoint was the rate of septic failure. Mean follow-up was 5 years (range, one to 8).
The most common organism isolated was Staphylococcus epidermidis (n = 45, 69.2%), and the most common polymicrobial combination was Staphylococcus epidermidis and Cutibacterium acnes (n = 9; 13.8%). Survivorship free from all-cause revision was 79.7% (95% confidence interval 71.6 to 87.8), while survivorship free from septic failure was 66.9% (95% confidence interval 59.1 to 74.7). There were 17 septic failures with a mean time-to-failure of 1.8 years (range, 0.2 to 5.6), most of which (92.3%) isolated the same organisms as the initial one-stage revision.
To our knowledge, this study represents the largest study reporting the outcomes of one-stage revision for polymicrobial PJI. Nearly one in three patients experienced septic failure at midterm follow-up. Future research should focus on identifying adjunctive therapies and optimizing selection criteria in patients who have polymicrobial PJI who undergo one-stage exchange arthroplasty.
由于有机会获取培养物，大多数外科医生传统上建议对患有多种微生物假体周围关节感染（PJI）的患者进行两阶段置换。因此，关于这一特定人群的一期策略的结果数据仍然极为有限。鉴于对一期翻修的兴趣重新燃起，本研究旨在评估因多种微生物PJI接受一期翻修全髋关节置换术（THA）患者的5年平均结果。
使用机构关节登记系统对2016年至2022年间患有多种微生物PJI并接受一期翻修THA的患者进行回顾性研究。PJI根据2018年国际共识会议标准进行定义。共有65例患者培养结果呈阳性，分离出两种或更多不同的微生物。平均年龄为60岁，66%为女性。主要终点是感染性失败率。平均随访时间为5年（范围为1至8年）。
分离出的最常见微生物是表皮葡萄球菌（n = 45，69.2%），最常见的多种微生物组合是表皮葡萄球菌和痤疮丙酸杆菌（n = 9；13.8%）。无全因翻修的生存率为79.7%（95%置信区间71.6至87.8），而无感染性失败的生存率为66.9%（95%置信区间59.1至74.7）。有17例感染性失败，平均失败时间为1.8年（范围为0.2至5.6年），其中大多数（92.3%）分离出的微生物与最初的一期翻修相同。
据我们所知，本研究是报告多种微生物PJI一期翻修结果的最大规模研究。近三分之一的患者在中期随访时出现感染性失败。未来的研究应侧重于确定辅助治疗方法，并优化接受一期置换关节成形术的多种微生物PJI患者的选择标准。
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