Two-stage revision for the culture-negative infected total hip arthroplasty : A comparative study.
Two-stage revision for the culture-negative infected total hip arthroplasty : A comparative study.
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DOI：
10.1302/0301-620x.100b1.bjj-2017-0626.r1
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Haddad FS
中科院分区：
文献类型：
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作者：
Ibrahim MS;Twaij H;Haddad FS
假体周围关节感染（PJI）仍然是全髋关节置换术（THA）后具有挑战性的并发症。它与高发病率、高死亡率和高费用有关。存在用于管理培养阳性患者的指南和方案。由于缺乏明确的指导，管理PJI的培养阴性患者对外科医生和更广泛的多学科团队构成了更大的挑战。我们的目的是比较50例连续培养阴性和50例连续培养阳性患者的治疗结局，这些患者因慢性感染接受了二期翻修THA，至少随访5年。两组患者的结局无显著差异，术后5年的再感染率相似，均为6%。培养阴性的PJIs与年龄较大、吸烟、从其他地方转诊和术前抗生素治疗有关。培养阴性患者的样本在第一阶段（抽吸）前、第一阶段（植入物取出）和第二阶段手术（再植入）期间均为阴性。为了控制这一困难患者群体的感染，我们采用与复杂的培养阳性PJI相同的两阶段翻修方法，严格遵守选择和治疗培养阴性PJI患者的方案是很重要的。引用这篇文章：Bone Joint J 2018;（1 Supple A）100-B：3-8。
Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA). It is associated with high levels of morbidity, mortality and expense. Guidelines and protocols exist for the management of culture-positive patients. Managing culture-negative patients with a PJI poses a greater challenge to surgeons and the wider multidisciplinary team as clear guidance is lacking. We aimed to compare the outcomes of treatment for 50 consecutive culture-negative and 50 consecutive culture-positive patients who underwent two-stage revision THA for chronic infection with a minimum follow-up of five years. There was no significant difference in the outcomes between the two groups of patients, with a similar rate of re-infection of 6%, five years post-operatively. Culture-negative PJIs were associated with older age, smoking, referral from elsewhere and pre-operative antibiotic treatment. The samples in the culture-negative patients were negative before the first stage (aspiration), during the first-stage (implant removal) and second-stage procedures (re-implantation). Adherence to strict protocols for selecting and treating culture-negative patients with a PJI using the same two-stage revision approach that we employ for complex culture-positive PJIs is important in order to achieve control of the infection in this difficult group of patients. Cite this article: Bone Joint J 2018;(1 Supple A)100-B:3–8.