Two-Stage Treatment of Periprostetic Infection: Mid-Term Results

封面


如何引用文章

全文:

详细

Purpose — to evaluate the efficiency of two-stage revision arthroplasty performed according to a standardized protocol by a multidisciplinary surgical team. Materials and Methods. 87 patients with deep periprosthetic hip and knee joint infection (PJI) were included into the prospective study. The patients were admitted to the clinic in the period from January 2012 until December 2014 and underwent two-stage revision procedure. First stage included removal of infected implant and insertion of a cemented spacer, second stage — re-implantation of a prosthesis. Results. Re-implantation of a prosthesis was performed in 89.7% (95% CI 82.8–95.4) of cases. Infection recurrence rate was 13.8% (95% CI 6.9–20.7) and 12.8% (95% CI 6.4–21.8) after the first and the second stage, respectively. Overall efficiency of two-stage procedure was 80,5% (95% CI 71.3–88.5) with a median of 4.7 year follow up. Conclusion. Rate of re-implantation, recurrent infection and newly occurred infection should be taken into consideration for evaluation of treatment efficiency. Application of single criteria for assessment of successful treatment outcomes will allow to compare various studies. Positive microbiological tests during the second stage of procedure are not a risk factor for recurrent infection but can be caused by contamination of specimens.

作者简介

V. Pavlov

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

Email: fake@neicon.ru
Vitaliy V. Pavlov — Dr. Sci. (Med.), Chief Researcher, Head of Department of Endoprosthetics and Endoscopic Joint Surgery 俄罗斯联邦

N. Petrova

National Medical Research Center for Children’s Health

Email: fake@neicon.ru
Natalia V. Petrova — Cand. Sci. (Med.), Head of Clinical Pharmacology Department 俄罗斯联邦

T. Sheraliev

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics

编辑信件的主要联系方式.
Email: sheraliev.taalai@mail.ru
Taalaibek U. Sheraliev — PhD Student 俄罗斯联邦

参考

  1. Ермаков А.М., Клюшин Н.М., Абабков Ю.В., Тряпичников А.С., Коюшков А.Н. Оценка эффективности двухэтапного хирургического лечения больных с перипротезной инфекцией коленного и тазобедренного суставов. Гений ортопедии. 2018;24(3):321-326. doi: 10.18019/1028-4427-2018-24-3-321-326.
  2. Parvizi J., Adeli B., Zmistowski B., Restrepo C., Greenwald A.S. Management of periprosthetic joint infection: the current knowledge: AAOS exhibit selection. J Bone Joint Surg Am. 2012;94(14):e104. doi: 10.2106/JBJS.K.01417.
  3. Kapadia B.H., Berg R.A., Daley J.A., Fritz J., Bhave A., Mont M.A. Periprosthetic joint infection. Lancet. 2016;387(10016):386-394. doi: 10.1016/S0140-6736(14)61798-0.
  4. Kurtz S.M., Lau E.C., Son M.S., Chang E.T., Zimmerli W., Parvizi J. Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population. J Arthroplasty. 2018;33(10):3238-3245. doi: 10.1016/j.arth.2018.05.042.
  5. Li C., Renz N., Trampuz A. Management of Periprosthetic Joint Infection. Hip Pelvis. 2018;30(3):138-146. doi: 10.5371/hp.2018.30.3.138.
  6. Parvizi J., Tan T.L., Goswami K., Higuera C., Della Valle C., Chen A.F., Shohat N. The 2018 Definition of Periprosthetic Hip and Knee Infection: An EvidenceBased and Validated Criteria. J Arthroplasty. 2018;33(5): 1309-1314.e2. doi: 10.1016/j.arth.2018.02.078.
  7. Akgün D., Müller M., Perka C., Winkler T. High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange. J Orthop Surg Res. 2019;14(1):78. doi: 10.1186/s13018-019-1122-0.
  8. Akgün D., Müller M., Perka, C., Winkler T. An often-unrecognized entity as cause of recurrent infection after successfully treated two-stage exchange arthroplasty: hematogenous infection. Arch Orthop Trauma Surg. 2018;138(9):1199-1206. doi: 10.1007/s00402-018-2972-3.
  9. Винклер Т., Трампуш А., Ренц Н., Перка К., Божкова С.А. Классификация и алгоритм диагностики и лечения перипротезной инфекции тазобедренного сустава. Травматология и ортопедия России. 2016;(1): 33-45. doi: 10.21823/2311-2905-2016-0-1-33-45.
  10. Parvizi J., Zmistowski B., Berbari E.F., Bauer T.W., Springer B.D., Della Valle C.J. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469(11): 2992-2994. doi: 10.1007/s11999-011-2102-9.
  11. Henderson R.A., Austin M.S. Management of Periprosthetic Joint Infection: The More We Learn, the Less We Know. J Arthroplasty. 2017;32(7):2056-2059. doi: 10.1016/j.arth.2017.02.023.
  12. Proceedings of the International Consensus on Periprosthetic Joint Infection. Parvizi J., Gehrke T., Chen A.F. Bone Joint J. 2013;95-B(11):1450-1452. doi: 10.1302/0301-620X.95B11.33135.
  13. Jämsen E., Stogiannidis I., Malmivaara A., Pajamäki J., Puolakka T., Konttinen Y.T. Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop. 2009;80(1):67-77. doi: 10.1080/17453670902805064.
  14. Diaz-Ledezma C., Higuera C.A, Parvizi J. Success after treatment of periprosthetic joint infection: a Delphibased international multidisciplinary consensus. Clin Orthop Relat Res. 2013; 471(7):2374-2382. doi: 10.1007/s11999-013-2866-1.
  15. Zmistowski B.M., Manrique J., Patel R., Chen A.F. Recurrent Periprosthetic Join Infection After Irrigation and Debridement With Component Retention Is Most Often Due to Identical Organisms. J Arthroplasty. 2016;31(9 Suppl):148-151. doi: 10.1016/j. arth.2016.05.040.
  16. Akgün D., Müller M., Perka C., Winkler T. A positive bacterial culture during re-implantation is associated with a poor outcome in two-stage exchange arthroplasty for deep infection. Bone Joint J. 2017;99-B(11):1490- 1495. doi: 10.1302/0301-620X.99B11.BJJ-2017-0243-R1.
  17. Tan T.L., Gomez M.M., Manrique J., Parvizi J., Chen A.F. Positive culture during reimplantation increases the risk of subsequent failure in two-stage exchange arthroplasty. J Bone Joint Surg Am. 2016;98(15): 1313-1319. doi: 10.2106/JBJS.15.01469.
  18. Bejon P., Berendt A., Atkins B.L., Green N., Parry H., Masters S. et al. Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology. J Antimicrob Chemother. 2010;65(3):569-575. doi: 10.1093/jac/dkp469.
  19. Hart W.J., Jones R.S. Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy. J Bone Joint Surg Br. 2006;88(8):1011-1015. doi: 10.1302/0301-620X.88B8.17445.
  20. Puhto A.P., Puhto T.M., Niinimäki T.T., Leppilahti J.I., Syrjälä H.P. Two-stage revision for prosthetic joint infection: outcome and role of reimplantation microbiology in 107 cases. J Arthroplasty. 2014;29(6):1101-1104. doi: 10.1016/j.arth.2013.12.027.
  21. Kini S.G., Gabr A., Das R., Sukeik M., Haddad F.S. Two-stage Revision for Periprosthetic Hip and Knee Joint Infections. Open Orthop J. 2016;10:579-588. doi: 10.2174/1874325001610010579.
  22. Romanò C.L., Gala L., Logoluso N., Romanò D., Drago L. Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers. Knee Surg Sports Traumatol Arthrosc. 2012;20(12):2445-2453. doi: 10.1007/s00167-012-1885-x.
  23. Lichstein P., Su S., Hedlund H., Suh G., Maloney W.J., Goodman S.B., Huddleston J.I. 3rd. Treatment of periprosthetic knee infection with a two-stage protocol using static spacers. Clin Orthop Relat Res. 2015;474(1):120-125. doi: 10.1007/s11999-015-4443-2.
  24. Cury Rde P., Cinagawa E.H., Camargo O.P., Honda E.K., Klautau G.B., Salles M.J. Treatment of infection after total knee arthroplasty. Acta Ortop Bras. 2015; 23(5): 239-243. doi: 10.1590/1413-785220152305138774.
  25. Lange J., Troelsen A., Søballe K. Chronic periprosthetic hip joint infection. A retrospective, observational study on the treatment strategy and prognosis in 130 nonselected patients. PLoS One. 2016;11(9):e0163457. doi: 10.1371/journal.pone.0163457.
  26. Mortazavi S.M.J., Vegari D., Ho A., Zmistowski B., Parvizi J. Two-stage exchange arthroplasty for infected total knee arthroplasty: Predictors of failure. Clin Orthop Relat Res. 2011;469(11):3049-3054. doi: 10.1007/s11999-011-2030-8.
  27. Преображенский П.М., Божкова С.А., Каземирский А.В., Гончаров М.Ю. Результаты этапного лечения пациентов с перипротезной инфекцией после эндопротезирования коленного сустава. Травматология и ортопедия России. 2017;23(1):98-107. doi: 10.21823/2311-2905-2017-23-1-98-107.
  28. Gomez M.M., Tan T.L., Manrique J., Deirmengian G.K., Parvizi J. The fate of spacers in the treatment of periprosthetic joint infection. J Bone Joint Surg Am. 2015;97(18):1495-1502. doi: 10.2106/JBJS.N.00958.
  29. Ермаков А.М., Клюшин Н.М., Абабков Ю.В., Тряпичников А.С., Коюшков А.Н. Оценка эффективности двухэтапного хирургического лечения больных с перипротезной инфекцией коленного и тазобедренного суставов. Гений Ортопедии. 2018;24(3): 321-326. doi: 10.18019/1028-4427-2018-24-3-321-326.
  30. Клюшин Н.М., Ермаков А.М., Абабков Ю.В., Коюшков А.Н. Истинная эффективность методики артродезирования при лечении перипротезной инфекции коленного сустава. Гений ортопедии. 2019;25(2): 156-161. doi: 10.18019/1028-4427-2019-25-2-156-161.
  31. Шпиняк С.П., Барабаш А.П., Гиркало М.В. Двухэтапное ревизионное эндопротезирование при перипротезной инфекции коленного сустава. Кафедра травматологии и ортопедии. 2016;19(3): 58-61. Режим доступа: http://jkto.ru/id-3/id-2/3-19- 2016-/id-10.html.
  32. Комаров Р.Н., Митрофанов В.Н., Новиков А.В., Королёв С.Б. Тактика леченя инфекционных осложнений после эндопротезирования тазобедренного сустава. Травматология и ортопедия России. 2016;22(4):25-34. doi: 10.21823/2311-2905-2016-22-4-25-34.
  33. Мурылев В.Ю., Куковенко Г.А., Елизаров П.М., Иваненко Л.Р., Сорокина Г.Л., Рукин Я.А., Алексеев С.С., Германов В.Г. Алгоритм первого этапа лечения поздней глубокой перипротезной инфекции тазобедренного сустава. Травматология и ортопедия России. 2018;24(4):95-104. doi: 10.21823/2311-2905-2018-24-4-95-104.

补充文件

附件文件
动作
1. JATS XML
下载

版权所有 © ,


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


##common.cookie##