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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Success of Debridement and Implant Retention in Periprosthetic Joint Infection – Does the Surgeon Matter?
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Success of Debridement and Implant Retention in Periprosthetic Joint Infection – Does the Surgeon Matter?

机译：清创术和假体植入在保留假体周围关节感染方面的成功–外科医生是否重要？

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Objective: Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty (TJA). In acute haematogenous and early post-operative PJI, debridement and implant retention (DAIR) surgery is often the initial treatment and success rates vary. This study aimed to identify factors affecting success rates of DAIR and in particular whether involvement of a lower limb arthroplasty surgeon can affect outcome. Method: This retrospective review included one hundred and sixty-two patients undergoing DAIR for first-episode PJI following hip and knee arthroplasty at one of three tertiary hospitals. Treatment success was defined as no relapse within two years of DAIR. Data on patient, hospital, and surgical factors were identified including duration of symptoms, time from primary, previous revisions, age of prosthesis, bacterial subtype, whether modular component exchange was performed and whether an arthroplasty surgeon performed the procedure. Adjusted multivariate analysis was performed to identify factors associated with success of the DAIR procedure. Results: Overall success rate of DAIR in both hip and knee arthroplasty was 60%. A specialist arthroplasty surgeon was present in 42% of cases. Arthroplasty surgeons performed modular exchange in 51% of cases compared to 32.5% for other surgeons. Inclusion of modular exchange in the procedure was the only factor associated with DAIR success (OR 3.1, p<0.013). Time to theatre of less than 24 hours (OR 0.59), duration of symptoms less than one week (OR 1.28), age of prosthesis less than 3 months (OR 1.47) and having an arthroplasty surgeon perform DAIR (OR 1.6) did not lead to statistically significant improvements in success rate. Conclusions: Modular exchange was associated with a significantly higher success rate for both hip and knee PJI, suggesting thorough debridement is important in DAIR. Arthroplasty surgeons were more likely to perform modular exchange, but their presence in theatre alone did not reduce the risk of failure.
机译：目的：人工关节感染（PJI）是全关节置换术（TJA）后的毁灭性并发症。在急性血行和术后PJI早期，清创和植入物保留（DAIR）手术通常是初始治疗，成功率各不相同。这项研究旨在确定影响DAIR成功率的因素，尤其是下肢关节置换术医师的介入是否会影响预后。方法：这项回顾性研究包括在三间三级医院之一的髋关节和膝关节置换术后接受第一期PJI的DAIR治疗的162例患者。治疗成功定义为DAIR两年内未复发。确定了有关患者，医院和手术因素的数据，包括症状的持续时间，初次手术的时间，以前的翻修时间，假体的年龄，细菌亚型，是否进行了模块化组件更换以及是否由关节置换术医师进行了手术。进行调整后的多元分析，以识别与DAIR程序成功相关的因素。结果：髋关节和膝关节置换术中DAIR的总成功率为60％。 42％的病例中有专科医生进行关节置换术。关节成形术外科医生在51％的病例中进行了模块化更换，而其他外科医生为32.5％。程序中包括模块化交换是与DAIR成功相关的唯一因素（OR 3.1，p <0.013）。手术时间少于24小时（OR 0.59），症状持续时间少于一周（OR 1.28），假体年龄少于3个月（OR 1.47）且由关节置换术医师进行DAIR（OR 1.6）导致统计上显着提高成功率。结论：模块化置换术与髋关节和膝关节PJI的成功率显着提高相关，表明彻底的清创术在DAIR中很重要。关节置换术外科医生更可能进行模块化置换，但仅在手术室就医并不能降低失败的风险。

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