Outcome of Irrigation and Debridement after Failed Two-Stage Reimplantation for Periprosthetic Joint Infection.
Outcome of Irrigation and Debridement after Failed Two-Stage Reimplantation for Periprosthetic Joint Infection.
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DOI：
10.1155/2018/2875018
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发表时间：
2018
影响因子：
--
通讯作者：
Kappe T
中科院分区：
文献类型：
--
作者：
Faschingbauer M;Boettner F;Bieger R;Weiner C;Reichel H;Kappe T
二期翻修是治疗膝关节或髋关节置换术后深部植入物感染的金标准。在30天内发生再感染或症状存在不超过3周的情况下，冲洗和清创可能是二期翻修失败的治疗选择，并且由于其发病率低而具有吸引力。我们确定了二期翻修失败的髋关节和膝关节置换术后冲洗和清创术后复发感染的发生率。 我们对2002年至2010年采用二期手术治疗的假体周围髋关节和膝关节感染进行了单中心回顾性分析。本研究选择了所有随后接受冲洗和清创术治疗后续感染的患者。 2002年至2010年期间进行了440例两阶段翻修。51例二期翻修失败（11.6%）。19例失败的二期翻修采用冲洗和清创术治疗; 12例（63.2%）患者在随访时保持无感染（平均随访：39个月;范围：24-90个月），6例患者（31.6%）感染持续存在，1例患者死亡（5.3%）。 两阶段手术失败的冲洗和清创成功率与原发性种植体感染的冲洗和清创成功率相似。根据当前的论文，如果在二期手术失败后的前30天内进行，或者如果在存在易感微生物的情况下症状存在不到3周，则冲洗和清创是二期翻修失败后急性再感染的可接受治疗。
Two-stage revision is the gold standard for the treatment of deep implant infection after knee or hip arthroplasty. Irrigation and debridement may be a treatment option for failed 2-stage revisions in cases where a reinfection occurs within 30 days or the symptoms exist not longer than 3 weeks and is appealing because of its low morbidity. We determined the incidence of recurrent infections following irrigation and debridement for failed two-stage revision hip and knee arthroplasty. We performed a single center retrospective review of periprosthetic hip and knee infections treated with a two-stage procedure from 2002 to 2010. All patients that subsequently underwent irrigation and debridement for a subsequent infection were selected for the current study. 440 two-stage revisions were performed between 2002 and 2010. Fifty-one two-stage revisions failed (11.6%). Nineteen failed two-stage revisions were treated with irrigation and debridement; 12 (63.2%) patients remained free of infection at follow-up (mean follow-up: 39 months; range, 24-90 months), infection persisted in 6 patients (31.6%), and 1 patient died (5.3%). Success rates of irrigation and debridement for failed two-stage procedures are similar to the success rates of irrigation and debridement in primary implant infections. According to the current paper, irrigation and debridement are an acceptable treatment for acute reinfections after failed two-stage revision if performed within the first 30 postoperative days after failed two-stage procedure or if symptoms are present for less than 3 weeks in the presence of a susceptible organism.
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