Sax Florian Hubert, Hoyka Marius, Blersch Benedikt Paul, Grünwald Leonard, Fink Bernd
Department for Joint Replacement, Rheumatoid and General Orthopaedics, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
J Clin Med. 2025 Sep 18;14(18):6556. doi: 10.3390/jcm14186556.
Two-stage septic hip revision arthroplasty has higher mortality rates than aseptic hip revision arthroplasty, and patients over 75 years have higher fracture rates than younger patients after cementless total hip arthroplasty. Therefore, the aim of this study was to examine whether two-stage septic hip revision arthroplasty in older patients leads to higher complication and mortality rates, as well as whether changing to cementless hip prostheses in older patients could lead to higher fracture and subsidence rates of the stem prosthesis than in younger patients. In total, 286 two-stage-revision procedures for periprosthetic infections of the hip in 186 patients younger and 118 patients older than 75 years were followed for a minimum of 24 (50.24 ± 20.77) months. A total of 71.3% of procedures were performed via a transfemoral approach using cementless cups and revision stems (93.7%). Complications and mortality were analyzed retrospectively. There was a one-year mortality rate of 1.0% with no difference in the groups, and a general mortality rate of 2.8% with a significantly higher rate in older adults than in the younger group (5.9% vs. 0.6%; = 0.01). The rate of fractures of the bony flap in transfemoral approaches (9.1%), fissure rate of the isthmus (2.8%), rate of subsidence of cementless stems (1.0%), and rate of reinfections (4.89%) did not differ between the two groups. The general complication rate (not associated with cementless two-stage septic revision) (22.0%) was significantly higher in the older patient group (33.9% vs. 13.7%; < 0.001). Septic two-stage revision hip arthroplasty, mostly using a transfemoral approach and cementless reimplantation, does not result in a higher one-year mortality rate, reinfection rate, and rate of fissures and fractures of the bony flap, but demonstrates a generally higher mortality and complication rate in older adults. This should be taken into consideration when determining the indication and when offering advice to older adults.
两期感染性髋关节翻修置换术的死亡率高于无菌性髋关节翻修置换术，且在非骨水泥型全髋关节置换术后，75岁以上患者的骨折发生率高于年轻患者。因此，本研究的目的是探讨老年患者行两期感染性髋关节翻修置换术是否会导致更高的并发症和死亡率，以及老年患者更换为非骨水泥型髋关节假体是否会比年轻患者导致更高的假体柄骨折和下沉率。总共对186例年龄小于75岁和118例年龄大于75岁患者的286例髋关节假体周围感染两期翻修手术进行了至少24（50.24±20.77）个月的随访。总共71.3%的手术采用经股骨入路，使用非骨水泥髋臼杯和翻修柄（93.7%）。对并发症和死亡率进行回顾性分析。一年死亡率为1.0%，两组无差异，总体死亡率为2.8%，老年组显著高于年轻组（5.9%对0.6%；P=0.01）。经股骨入路的骨瓣骨折率（9.1%）、峡部裂隙率（2.8%）、非骨水泥柄下沉率（1.0%）和再感染率（4.89%）在两组之间无差异。老年患者组的总体并发症发生率（与非骨水泥型两期感染性翻修无关）（22.0%）显著高于年轻患者组（33.9%对13.7%；P<0.001）。感染性两期翻修髋关节置换术，大多采用经股骨入路和非骨水泥再植入，不会导致更高的一年死亡率、再感染率以及骨瓣裂隙和骨折率，但老年患者的总体死亡率和并发症发生率普遍较高。在确定手术指征和向老年患者提供建议时应考虑到这一点。
