HIP International最新文献

{"title":"The 'Quartered Head Technique': a simple, reliable way of maintaining leg length and offset during total hip arthroplasty.","authors":"Oluwatobi O Onafowokan, Muhammad Haruna, Alasdair R Bott, Ewan Bigsby, Rory G Middleton, Gavin Holt","doi":"10.1177/11207000241302471","DOIUrl":"10.1177/11207000241302471","url":null,"abstract":"<p><strong>Introduction: </strong>Various techniques have been described for restoring leg length and offset during total hip arthroplasty (THA). We herein describe a novel \"Quartered Head Technique\" (QHT) involving a series of femoral osteotomies.</p><p><strong>Methods: </strong>124 hips were included in the analysis. An anterolateral approach was used in all cases. Leg length, and offset were assessed intraoperatively and reproduced using the QHT. A leg-length discrepancy (LLD) of <6 mm was chosen as acceptable based on previously published literature. Postoperative pelvic radiographs were assessed by two independent observers to ensure inter-observer reliability.</p><p><strong>Results: </strong>The mean absolute postoperative difference in leg length from the contralateral leg was +3.58 mm. 84% of patients had LLD within ±6 mm of the contralateral limb. Mean absolute postoperative difference in offset from the contralateral leg was +3.88 mm. 90% of patients were within ±6 mm offset of the contralateral limb. There was no statistical difference noted between observer measurement.</p><p><strong>Conclusions: </strong>The QHT provides a simple, inexpensive, yet effective method of maintaining femoral leg length and offset during total hip arthroplasty.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"33-40"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes associated with hip preservation using osteochondral allograft transplants and acetabular labrum reconstruction.","authors":"Kylee Rucinski, James L Cook, Cory R Crecelius, Brett D Crist","doi":"10.1177/11207000241288445","DOIUrl":"10.1177/11207000241288445","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral allograft (OCA) transplantation with or without labral reconstruction is considered a hip preservation surgical treatment option for young, active patients. This study aims to report early outcomes for use of OCA and labrum allograft transplants for patients treated for symptomatic femoral head chondral damage and/or acetabular labrum deficiency after implementation of a comprehensive joint restoration approach.</p><p><strong>Methods: </strong>33 patients from a lifelong registry were included for analysis. Outcomes were compared for statistically significant (<i>p</i> < 0.05) differences based on graft preservation methodology (standard preservation [SP] vs. Missouri Osteochondral Preservation System [MOPS]), and based on surfaces treated (femoral head only, labrum only, or femoral head and labrum).</p><p><strong>Results: </strong>Mean follow-up duration was 44.8 (range 12-95) months. Success was documented in 28 (84.8%) patients. For the SP cohort, successful outcomes were documented in 5 cases (50%), while all 23 MOPS cases (100%) were deemed successful at least 1 year after surgery. Hip preservation surgeries performed using MOPS grafts were associated with significantly (<i>p</i> = 0.001; OR = 47x) higher success rates, including significant and clinically meaningful improvements in PROMs at 1 and 2 years after surgery. Revision was performed in 2 patients in the SP cohort and failure requiring total hip arthroplasty was documented in 3 SP patients. Mean time to revision or failure was 23.6 (range 4-43) months. The surfaces treated were significantly associated with failure when comparing patients undergoing a femoral head OCA with or without labral reconstruction to those undergoing labral reconstruction only (<i>p</i> = 0.03; OR = 8.3x).</p><p><strong>Conclusions: </strong>Patients with symptomatic femoral head cartilage loss and/or irreparable acetabular labrum deficiency undergoing femoral head OCA transplantation and/or labral reconstruction with meniscus allografts using MOPS-preserved tissues experienced statistically significant and clinically meaningful improvements in pain and function through at least 2 years after surgery.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"9-17"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse spinopelvic mobility in patients undergoing total hip arthroplasty is associated with high mobility of the hip in a flexed seated position.","authors":"Thomas Aubert, Aurelien Halle, Philippe Gerard, Guillaume Riouallon, Guillaume Auberger, Luc Lhotellier","doi":"10.1177/11207000241284260","DOIUrl":"10.1177/11207000241284260","url":null,"abstract":"<p><strong>Purpose: </strong>Adverse spinopelvic mobility from a standing to a flexed seated position of more than 20° of the spinopelvic tilt (∆SPT) has been shown to have a high risk of dislocation. If hypermobility of the hip analysed with the pelvic femoral angle (∆PFA) has a high risk of impingement, the correlation between the range of motion of the hip from a standing to a flexed seated position and its implication in adverse spinopelvic mobility has not been described.</p><p><strong>Methods: </strong>A series of 337 patients treated with primary THA underwent lateral x-ray in standing and flexed seated positions to analyse ∆SPT, ∆PFA and spinopelvic parameters. The objectives were to establish a ∆PFA threshold associated with a ∆SPT ⩾20° and to subsequently investigate its influence in conjunction with spinopelvic risk factors on the occurrence of adverse spinopelvic mobility.</p><p><strong>Results: </strong>The area under the curve was 0.904 (95%CI, 0.864-0.945) for ∆PFA to predict ∆SPT ⩾ 20°; it was predicted by ∆PFA ⩾ 95° with a sensitivity of 91.7% and a specificity of 74.4% at the Youden optimal threshold. Patients with a ∆SPT < 20° (277 patients) had a mean ∆PFA of 83° compared to 110° if ∆SPT ⩾ 20° (60 patients) (<i>p</i> < 0.001). Patients with a ∆PFA < 95° (203 patients) had a mean ∆SPT of -6° compared to 18° if ∆PFA ⩾ 95° (134 patients) (<i>p</i> < 0.001). ∆PFA ⩾ 95° rates were 95% (57/60) and 27.8% (77/200) in patients with ∆SPT ⩾ 20° and ∆SPT < 20°, respectively (OR 49.35; CI, 15.01-162.28; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>High mobility of the hip (∆PFA ⩾ 95°) seems to be a necessary condition for adverse spinopelvic mobility. A preoperative analysis of patients with lower hip mobility, associated with spinopelvic risk factors, might identify patients with abnormal spinopelvic mobility after the restoration of femoral flexion.</p><p><strong>Trial registration: </strong>IDRCB 2023-A01390, CNIL MR004 2225508 (07/06/2023), retrospectively registered.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"47-53"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and radiological outcomes and complications of Bernese periacetabular osteotomy through modified Stoppa approach.","authors":"Deniz Akbulut, Mehmet Coskun","doi":"10.1177/11207000241280951","DOIUrl":"10.1177/11207000241280951","url":null,"abstract":"<p><strong>Background: </strong>The Smith-Peterson approach and its modifications provide an extensive exposure and allow osteotomies through a single incision. However, the risk of complications increases when the quadrilateral surface, ischial and pubic osteotomy sites cannot be seen. This study aimed to evaluate the surgical characteristics, complications, and functional and radiological outcomes of patients with acetabular dysplasia who underwent Bernese periacetabular osteotomy (PAO) through modified Stoppa approach and plate-screw fixation.</p><p><strong>Methods: </strong>The study included 31 patients (41 hips) who had undergone PAO using a modified Stoppa approach. The characteristics of patients and the surgical procedure were described. The lateral centre-edge angle (LCEA) and Tönnis roof angle were evaluated in the radiological outcome evaluation. The modified Harris Hip Score (mHHS) was used to evaluate functional outcome. Furthermore, complications were described.</p><p><strong>Results: </strong>The mean age of the patients was 20.4 ± 9.0 years. Of the 31 patients, 21 underwent unilateral Bernese PAO and 10 underwent bilateral Bernese PAO. The mean follow-up period was 25.1 ± 8.8 months. Postoperatively, the mean mHHS improved significantly (68.8 ± 9.4 vs. 88.8 ± 10.0, <i>p</i> < 0.001). Postoperatively, the mean LCEA and Tönnis roof angle improved significantly (17.7 ± 6.0 vs. 42.2 ± 4.8, <i>p</i> < 0.001 for LCEA and 18.3 ± 5.5 vs. 8.0 ± 2.2, <i>p</i> < 0.001 for Tönnis roof angle). There was no significant correlation between preoperative to postoperative improvement in LCEA or Tönnis roof angle and improvement and mHHS (<i>p</i> > 0.005). 5 complications were identified: 1 transient sciatic nerve palsy, 1 external iliac vein injury, 1 infection, and 2 screw irritations of acetabulum.</p><p><strong>Conclusions: </strong>Performing Bernese PAO through a modified Stoppa approach with plate-screw fixation results in acceptable complication rates, immediate early weight-bearing opportunity, and improved functional and radiological outcomes in patients with acetabular dysplasia.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"83-91"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The L1 spino-pelvic (L1SP) angle: a simplified approach for the assessment of the PI-LL mismatch in hip surgery.","authors":"A Mounir Boudali, Yuan Chai, John E Farey, Jonathan Vigdorchik, William L Walter","doi":"10.1177/11207000241282984","DOIUrl":"10.1177/11207000241282984","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic incidence - lumbar lordosis (PI-LL) mismatch is often considered when assessing spinopelvic alignment in the sagittal plane. The mismatch is conventionally obtained by measuring 2 separate angles on lateral spinopelvic radiographs. This study describes a simplified approach for assessing spinopelvic mobility and measuring the PI-LL mismatch through the evaluation of the L1-spinopelvis angle (L1SP).</p><p><strong>Methods: </strong>96 standing lateral radiographs were obtained from consecutive patients presenting for total hip arthroplasty between November 2020 and July 2021. 3 operators were recruited to annotate landmarks on digital radiographs. Correlation analysis and error analysis were applied. Measurement reproducibility was assessed using intraclass correlation coefficient (ICC).</p><p><strong>Results: </strong>The correlation coefficients of the 3 variables were respectively 0.87 for PI, 0.94 for LL, and 0.96 for L1SP. The normalised root mean square error between the 2 measurement sets was 9.96% for PI, 5.97% for LL, and 4.41% for L1SP. The absolute error was 3.49° ± 4.63° for PI, 3.23° ± 3.78° for LL, 2.68° ± 3.19° for PI-LL conventional, and 2.35° ± 2.88° for PI-LL via L1SP, respectively. In terms of reproducibility, measurement of L1SP outperformed that of PI and LL (ICC = 0.97 versus 0.83 and 0.93, respectively).</p><p><strong>Conclusion: </strong>The simplified L1SP method, through the measurement of a single angle, produced similar measurements to the conventional PI-LL method. The measurement repeatability between operators was improved using the L1SP method. From a clinical practice perspective, both methods are equivalent. The new method is readily reproducible using commercially available PACS software during preoperative templating.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"41-46"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142285865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transition from straight lateral to direct anterior approach in total hip arthroplasty: a retrospective single-centre study.","authors":"Lambert C E Visser, Noa H M Ponds, Ellie B M Landman, Stijn A A N Bolink","doi":"10.1177/11207000241285388","DOIUrl":"10.1177/11207000241285388","url":null,"abstract":"<p><strong>Introduction: </strong>The muscle-sparing direct anterior approach (DAA) for total hip arthroplasty (THA) has gained popularity for reduced postoperative pain and faster rehabilitation. The aim of this study was to evaluate the potential benefits of transitioning from straight lateral approach (SLA) THA to DAA THA, and investigate whether these benefits outweigh potential disadvantages of the DAA learning curve.</p><p><strong>Method: </strong>Patients undergoing surgery between 2015 and 2020 (<i>n</i> = 2275) were categorised into three periods: pre-transition period (2015-2016) utilizing SLA exclusively, transition period (2017-2018) incorporating both SLA and DAA, and post-transition period (2019-2020) employing only DAA. The Hip disability and Osteoarthritis Outcome Score - Physical function Short-form (HOOS-PS) was recorded pre-surgery and one-year post-surgery. Furthermore, complications, blood loss, duration of surgery and length of stay were compared between groups.</p><p><strong>Results: </strong>A larger improvement in HOOS-PS score was found for DAA in comparison with SLA (37.13 ± 18.62 vs. 32.55 ± 22.83; <i>p</i> < 0.001). Significant improvements were found for the DAA group regarding duration of surgery (70:02 ± 15:54 min vs. 79:47 ± 15:03 min; <i>p</i> < 0,001) and length of stay (1.68 ± 1.80 days vs. 3.39 ± 1.85 days; <i>p</i> < 0,001) compared to the SLA group. Total number of complications was higher for SLA (<i>n</i> = 87 (9.2%)) compared to DAA (<i>n</i> = 77 (6.5%); <i>p</i> = 0.018), with more femoral fractures for SLA (<i>n</i> = 35 (3.7%) vs. <i>n</i> = 6 (0.5%); <i>p</i> < 0.001) whereas more dislocations were found for DAA (<i>n</i> = 24 (2.0)% vs. <i>n</i> = 7 (0.7%); <i>p</i> = 0.017). More specifically, a higher number of dislocations occurred during the DAA transition period when compared to the SLA pre-transition period (<i>n</i> = 12 (2.7%) vs. <i>n</i> = 4 (0.6%); <i>p</i> = 0.008).</p><p><strong>Conclusions: </strong>Transitioning from SLA to DAA for THA improves patient-reported outcomes but does not seem to result in a higher overall complication rate. Suggesting the advantages of the DAA outweigh the potential disadvantages of the learning curve.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"25-32"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air arthrography: a safe technique for intra-articular hip injections.","authors":"Shannon Tse, Ashley K Chut, Jonathan Hutt","doi":"10.1177/11207000241301036","DOIUrl":"10.1177/11207000241301036","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnosing the specific causes of young adult hip pain remains challenging due to non-specific symptoms. Fluoroscopy-guided injections are useful for confirming intra-articular hip pain and differentiating it from extra-articular pathology. When performing injections, accurate needle placement into the hip joint is critical. Traditionally, a contrast agent is used to confirm intra-articular positioning. Air arthrograms are an alternative technique that avoids adverse reactions to contrast, which may compromise interpretation of results, as well as being more cost-effective. This study presents the air arthrography technique for intra-articular hip injections, and assesses outcomes and complications in a consecutive patient cohort.</p><p><strong>Methods: </strong>A retrospective review was performed on patients who underwent an air arthrography guided intra-articular hip injection at a single institution between April 2019 and September 2022. We identified 352 hips in 294 patients. Patient records were evaluated for complications from the injection or any subsequent hip surgery.</p><p><strong>Results: </strong>Mean age at time of injection was 38 years (±14.7 SD) for 216 females and 78 males. Mean follow-up time post injection was 138 days (IQR = 46-186). Results showed a 2.56% complication rate, primarily attributed to steroid flares, all of which resolved without further intervention. 102 patients proceeded to subsequent hip surgery; the mean time from injection to procedure was 341 days (IQR = 194-456) and the mean follow-up post subsequent procedure was 346 days (IQR = 87-531). There were no infective complications following the injections or any subsequent procedures.</p><p><strong>Conclusions: </strong>This is the first study that evaluates longer-term patient outcomes following air arthrography guided injections with or without subsequent surgery. Our results demonstrate that the use of air arthrograms is a reliable, safe, and cost-effective method for intra-articular hip injections, without the additional risks posed by contrast media.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"4-8"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and risk factors of pulmonary embolism after total hip arthroplasty: an NSQIP study.","authors":"Halil Bulut, Maria Jose Maestre, Daniel Tomey","doi":"10.1177/11207000241270205","DOIUrl":"10.1177/11207000241270205","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary embolism (PE) is a well-known contributor to morbidity after total hip arthroplasty (THA). Considerable efforts have been invested in reducing PE occurrence through pharmacological and perioperative interventions. Nonetheless, the effectiveness of these strategies in reducing the incidence and overall mortality associated with pulmonary embolism events remains a matter of debate. Therefore, identifying risky patients has been gaining importance.</p><p><strong>Methods: </strong>We utilised data from the National Surgical Quality Improvement Program (NSQIP) participant usage file (PUF) database spanning the years 2016 to 2021. All preoperative parameters were analysed with chi-square afterwards, meaningful ones were run with logistic regression test.</p><p><strong>Results: </strong>A study examined factors influencing pulmonary embolism (PE) prevalence in 235,393 total hip arthroplasty patients. Univariate analysis identified significant associations between PE and female gender, diabetes, smoking, dyspnea, CHF, COPD, hypertension (HT), bleeding disorders, disseminated cancer, steroid use, and functional health status. Multivariate analysis revealed male gender as protective, while COPD, hypertension, and disseminated cancer increased PE risk. Notably, smoking appeared protective. PE patients had higher return-to-operation rates (41.7% vs. 2.2%) but similar 30-day mortality (0.2% vs. 0.04%), though mortality's odds ratio was not significant.</p><p><strong>Conclusions: </strong>Our findings suggest that certain patient characteristics, such as COPD and metastatic malignancy, significantly influence the likelihood of PE development.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"70-75"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same same but different: Introduction of a classification system in calcar-guided short-stem total hip arthroplasty.","authors":"Karl P Kutzner","doi":"10.1177/11207000241286259","DOIUrl":"10.1177/11207000241286259","url":null,"abstract":"<p><strong>Background: </strong>The concept of calcar-guided short-stem THA (ssTHA) has largely emerged over the last decade, especially in Europe, and today modern calcar-guided short stems are among the most successful primary femoral implants in terms of complications and revision rates as indicated by multiple registry data. The philosophy originally comprised an individualised reconstruction of the hip anatomy by following the calcar of the femoral neck providing bone- and soft-tissue-sparing characteristics. However, as the stem design allows either metaphyseal fixation alone or additional diaphyseal anchoring, depending on the stem alignment and indication, distinct knowledge is required regarding the implantation technique, the broad variation of positioning and fixation and its potential clinical consequences.</p><p><strong>Aim: </strong>To report on and highlight the characteristics of different ways of performing calcar-guided ssTHA as well as to introduce a classification in order to systematically account for the variety of strategies and the respective implications on the type of fixation.</p><p><strong>Surgical technique: </strong>Already when templating preoperatively, surgeons need to weigh up the different fixation types taking into account a number of patient-related factors. Intraoperatively, by individually controlling the level of osteotomy, the intended type of anchorage can be implemented. Intraoperative radiography to confirm the result, is mandatory.</p><p><strong>Results: </strong>Despite numerous options of stem alignment, depending on the patient's anatomy, the bone quality or the indication for operation, a total of 4 categories were identified to characterise different fixation strategies in calcar-guided ssTHA.</p><p><strong>Conclusions: </strong>The classification system should be used for the preoperative determination of the intended type of anchorage. Whenever a short-stem philosophy with metaphyseal fixation (Type I (M)) is possible, it should be pursued.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"54-61"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective multicentre study of 82 prosthetic joint infections treated with a standardised debridement and implant retention (DAIR) protocol followed by 6 weeks of antimicrobial therapy: favourable results.","authors":"Øystein E Karlsen, Finnur Snorrason, Marianne Westberg","doi":"10.1177/11207000241295604","DOIUrl":"10.1177/11207000241295604","url":null,"abstract":"<p><strong>Introduction: </strong>Prosthetic joint infection (PJI) is a much-feared complication in total joint arthroplasty. Debridement, antibiotics, irrigation and implant retention (DAIR) is often the preferred treatment in acute PJIs, but with varying results. The primary aim of this study was to evaluate the outcome of a high quality DAIR procedure performed according to a consistently applied surgical protocol in early postoperative and acute haematogenous PJIs in hip and knee, and secondary to study risk factors associated with failure.</p><p><strong>Methods: </strong>We performed a prospective multicentre study to evaluate the effect of a standardised protocol-based surgical management (DAIR) emphasising a thorough debridement, followed by 6 weeks of antimicrobial therapy. Empiric parenteral antimicrobial treatment was administered until the results of susceptibility tests were available. No suppressive antimicrobial therapy was given after the 6-week treatment-period. Primary outcome measure was infection control at the 2-year follow-up.</p><p><strong>Results: </strong>A total of 99 patients from 8 Norwegian hospitals were found eligible and included in the study, and 82 patients were finally analysed. 69 of 82 patients (84% [CI, 76-92%]) were successfully treated with this treatment protocol. We found a reduced success rate when patients were treated with a DAIR procedure following an infected revision arthroplasty compared with an infected primary arthroplasty (11/17 (65 %) versus 58/65 (89 %), respectively (<i>p</i> = 0.02).</p><p><strong>Conclusions: </strong>The success rate of a standardised DAIR procedure with a 6-week antimicrobial treatment was good in PJI following primary arthroplasties. The success rate following PJI in revision arthroplasty was poor, and other treatment options should be considered.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"62-69"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}