{"title":"大型假体相关感染的时间特异性清创、抗生素、种植体保留和2期翻修:优化窗口期以改善预后","authors":"Rajeev K. Sharma MS, DNB, Mch , Imelda Lumban-Gaol MD , Udit Vinayak MS, DNB , Nicolaas C. Budhiparama MD, PhD","doi":"10.1016/j.artd.2025.101688","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the outcomes of debridement, antibiotics, and implant retention (DAIR) procedures and 2-stage revision surgeries in patients with periprosthetic joint infection following megaprosthesis, including treatment failure; the patient-reported outcomes; and to determine the survival rates of the revised megaprosthesis.</div></div><div><h3>Methods</h3><div>A retrospective study of 30 patients diagnosed with periprosthetic joint infection following megaprosthesis between 2018 and 2023, with minimum 1-year follow-up. Patients with previous unsuccessful debridement in other institutions were excluded. Patients presenting within 4 weeks of megaprosthesis implantation underwent the DAIR procedure, while those presenting after this window were taken for a 2-stage revision surgery. The primary outcome was treatment failure, defined as persistent wound complication or the need for subsequent surgical intervention. The secondary outcomes included patient-reported outcomes, assessed with the Oxford Hip Score and Oxford Knee Score, and the survival rates of the revised megaprosthesis.</div></div><div><h3>Results</h3><div>The mean follow-up duration for all patients was 38 ± 12.6 months. Improvement was found for Oxford Hip Score and Oxford Knee Score with mean 34.22 ± 9.2 and 32.40 ± 8.1, respectively, at the 1-year follow-up. DAIR achieved an 81% success rate (13 out of 16) and 2-stage exchange had a 71.4% success rate (10 out of 14).</div></div><div><h3>Conclusions</h3><div>Both DAIR and 2-stage exchange procedures yielded favorable functional outcomes with satisfactory 2-year survival function. Careful patient selection and indication management are crucial for optimal results.</div></div><div><h3>Level of evidence</h3><div>Level IV.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101688"},"PeriodicalIF":2.1000,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Timing-specific Debridement, Antibiotics, and Implant Retention and 2-Stage Revision for Megaprosthesis-Related Infection: Optimizing the Window Period for Improved Outcomes\",\"authors\":\"Rajeev K. Sharma MS, DNB, Mch , Imelda Lumban-Gaol MD , Udit Vinayak MS, DNB , Nicolaas C. Budhiparama MD, PhD\",\"doi\":\"10.1016/j.artd.2025.101688\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>This study aimed to evaluate the outcomes of debridement, antibiotics, and implant retention (DAIR) procedures and 2-stage revision surgeries in patients with periprosthetic joint infection following megaprosthesis, including treatment failure; the patient-reported outcomes; and to determine the survival rates of the revised megaprosthesis.</div></div><div><h3>Methods</h3><div>A retrospective study of 30 patients diagnosed with periprosthetic joint infection following megaprosthesis between 2018 and 2023, with minimum 1-year follow-up. Patients with previous unsuccessful debridement in other institutions were excluded. Patients presenting within 4 weeks of megaprosthesis implantation underwent the DAIR procedure, while those presenting after this window were taken for a 2-stage revision surgery. The primary outcome was treatment failure, defined as persistent wound complication or the need for subsequent surgical intervention. The secondary outcomes included patient-reported outcomes, assessed with the Oxford Hip Score and Oxford Knee Score, and the survival rates of the revised megaprosthesis.</div></div><div><h3>Results</h3><div>The mean follow-up duration for all patients was 38 ± 12.6 months. Improvement was found for Oxford Hip Score and Oxford Knee Score with mean 34.22 ± 9.2 and 32.40 ± 8.1, respectively, at the 1-year follow-up. DAIR achieved an 81% success rate (13 out of 16) and 2-stage exchange had a 71.4% success rate (10 out of 14).</div></div><div><h3>Conclusions</h3><div>Both DAIR and 2-stage exchange procedures yielded favorable functional outcomes with satisfactory 2-year survival function. Careful patient selection and indication management are crucial for optimal results.</div></div><div><h3>Level of evidence</h3><div>Level IV.</div></div>\",\"PeriodicalId\":37940,\"journal\":{\"name\":\"Arthroplasty Today\",\"volume\":\"33 \",\"pages\":\"Article 101688\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-04-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroplasty Today\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2352344125000755\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroplasty Today","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352344125000755","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Timing-specific Debridement, Antibiotics, and Implant Retention and 2-Stage Revision for Megaprosthesis-Related Infection: Optimizing the Window Period for Improved Outcomes
Background
This study aimed to evaluate the outcomes of debridement, antibiotics, and implant retention (DAIR) procedures and 2-stage revision surgeries in patients with periprosthetic joint infection following megaprosthesis, including treatment failure; the patient-reported outcomes; and to determine the survival rates of the revised megaprosthesis.
Methods
A retrospective study of 30 patients diagnosed with periprosthetic joint infection following megaprosthesis between 2018 and 2023, with minimum 1-year follow-up. Patients with previous unsuccessful debridement in other institutions were excluded. Patients presenting within 4 weeks of megaprosthesis implantation underwent the DAIR procedure, while those presenting after this window were taken for a 2-stage revision surgery. The primary outcome was treatment failure, defined as persistent wound complication or the need for subsequent surgical intervention. The secondary outcomes included patient-reported outcomes, assessed with the Oxford Hip Score and Oxford Knee Score, and the survival rates of the revised megaprosthesis.
Results
The mean follow-up duration for all patients was 38 ± 12.6 months. Improvement was found for Oxford Hip Score and Oxford Knee Score with mean 34.22 ± 9.2 and 32.40 ± 8.1, respectively, at the 1-year follow-up. DAIR achieved an 81% success rate (13 out of 16) and 2-stage exchange had a 71.4% success rate (10 out of 14).
Conclusions
Both DAIR and 2-stage exchange procedures yielded favorable functional outcomes with satisfactory 2-year survival function. Careful patient selection and indication management are crucial for optimal results.
期刊介绍:
Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.