髋关节置换术中的感染管理：翻修策略的比较见解

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-30 DOI:10.1016/j.jcot.2025.103079

Narendra Singh Kushwaha , Pushprajan , Ankur Ojha , Ashish Kumar , Mohit Kumar Patel , Shriansh Pandey

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引用次数: 0

摘要

背景：假体周围关节感染（PJI）仍然是全髋关节置换术（THA）后的主要并发症，通常需要翻修手术。关于单阶段和两阶段复习策略之间的最佳方法的争论仍然存在。方法对60例接受改良THA治疗慢性PJI的患者（每组30例）进行回顾性比较研究。患者在人口学上匹配，并在24个月内评估结果。主要终点包括感染复发和功能评分，包括疼痛的视觉模拟评分（VAS）。结果在24个月的随访中，两组均未出现再感染（两组复发率均为0%）。单期组术后3、6、12个月VAS评分稍好（6个月平均1.9 vs 2.2, p = 0.24）。两阶段组的住院时间更长，总体医疗费用更高。多微生物感染在两阶段队列中更为常见（20%对10%），而所有病例中有15%为培养阴性。金黄色葡萄球菌为主要病原菌，分别占46.7%和50.0%。在24个月时，单阶段的Harris髋关节评分平均为85.4±6.2，而两阶段的Harris髋关节评分平均为83.3±7.1。结论两种改良策略治疗慢性PJI均可行，且再感染率相当。然而，单阶段翻修可能提供更快的疼痛缓解和减少资源利用。临床决策应考虑感染类型、机体特征、患者合并症和外科专业知识等因素。

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Infection management in hip arthroplasty: Comparative insights on revision strategies

Background

Periprosthetic joint infection (PJI) remains a major complication following total hip arthroplasty (THA), often necessitating revision surgery. Debate persists regarding the optimal approach between single-stage and two-stage revision strategies.

Methods

This retrospective comparative study evaluated 60 patients (30 in each group) undergoing revision THA for chronic PJI. Patients were matched demographically, and outcomes were assessed over 24 months. Primary endpoints included infection recurrence and functional scores, including the Visual Analog Scale (VAS) for pain.

Results

At 24-month follow-up, neither group demonstrated reinfection (0 % recurrence in both cohorts). VAS scores were slightly better in the single-stage group at 3, 6, and 12 months postoperatively (mean 1.9 vs 2.2 at 6 months, p = 0.24). The two-stage group had longer hospital stays and greater overall healthcare costs. Polymicrobial infections were more common in the two-stage cohort (20 % vs. 10 %), while 15 % of all cases were culture-negative. Staphylococcus aureus was identified as the primary pathogen in 46.7 % and 50.0 % of the respective groups. At 24 months, the Harris Hip Score averaged 85.4 ± 6.2 for single-stage compared to 83.3 ± 7.1 for two-stage revisions.

Conclusion

Both revision strategies are viable for managing chronic PJI, with comparable reinfection rates. However, single-stage revision may offer faster pain relief and reduced resource utilization. Clinical decision-making should consider factors such as infection type, organism profile, patient comorbidities, and surgical expertise.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.