Outcome of short versus long interval in two-stage exchange for periprosthetic joint infection: a prospective cohort study

被引：41

作者：

Winkler, Tobias ^{[1
,2
,3
,4
,5
,6
,7
]}

Stuhlert, Malte G. W. ^{[1
,4
,5
,6
,7
]}

Lieb, Elke ^{[1
,4
,5
,6
,7
]}

Mueller, Michael ^{[1
,4
,5
,6
,7
]}

von Roth, Philipp ^{[1
,4
,5
,6
,7
]}

Preininger, Bernd ^{[1
,4
,5
,6
,7
]}

Trampuz, Andrej ^{[1
,3
,4
,5
,6
,7
]}

Perka, Carsten F. ^{[1
,4
,5
,6
,7
]}

机构：

[1] Ctr Musculoskeletal Surg, Augustenburger Pl 1, D-13353 Berlin, Germany

[2] Julius Wolff Inst, Berlin, Germany

[3] Berlin Brandenburg Ctr Regenerat Therapies, Berlin, Germany

[4] Charite Univ Med Berlin, Berlin, Germany

[5] Free Univ Berlin, Berlin, Germany

[6] Humboldt Univ, Berlin, Germany

[7] Berlin Inst Hlth, Berlin, Germany

来源：

ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY | 2019年 / 139卷 / 03期

关键词：

Periprosthetic joint infection; Two-stage revision; Interval length; Hip arthroplasty; Knee arthroplasty; Infection management; HIP-ARTHROPLASTY; SHORT-TERM; REVISION; SONICATION; DIAGNOSIS; CONSENSUS; SURVIVAL; FLUID;

D O I：

10.1007/s00402-018-3052-4

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

IntroductionA two-stage exchange is the standard treatment approach for chronic periprosthetic joint infection (PJI). While a 6-8week interval is commonly used before reimplantation, the optimal length of the prosthesis-free interval has not yet been determined. We evaluated the influence of a short (<4weeks) and long (4weeks) interval on reinfection rate and functional outcome of hip and knee PJI.MethodsIn this prospective cohort, patients undergoing two-stage revision for PJI were assigned to prosthesis reimplantation after a short (<4weeks) or long (4weeks) interval. All patients received standardized antimicrobial therapy, which consisted of antibiogram-adapted, non-biofilm-active antibiotics during the interval and an antimicrobial combination therapy with biofilm-active antibiotics after reimplantation. Follow-up was performed for infection, joint function, pain, need for care and quality of life.ResultsThirty-eight patients undergoing two-stage revision for PJI (18 hips and 20 knees) were included. Short interval was used in 19 patients having a mean interval of 17.9days (range 7-27days), long interval in 19 patients having a mean interval of 63.0days (range 28-204days). At a mean follow-up of 39.5months (range 32-48months), 37 of 38 patients (97.4%) were infection-free. One failure occurred among patients with long interval and none among patients with short interval. Functional results (ROM, HHS, KSS, VAS) and quality of life (SF-36) were similar in both groups. Patients treated with long interval required cumulatively additional 204 inpatient days for nursing care compared to patients with short interval.ConclusionsThis study suggests that two-stage exchange with short interval has a similar outcome than with long interval, when highly active antibiotic therapy is used. Patient inconvenience and care costs due to immobilization were lower when strategies with a short interval were used.

引用

页码：295 / 303

页数：9

共 32 条

[1] A positive bacterial culture during reimplantation is associated with a poor outcome in two-stage exchange arthroplasty for deep infection [J].