急性膝假体周围感染保留假体治疗8年经验

[目的]探讨清创保留假体(debridement,antibiotics and implant retention,DAIR)联合滴注引流治疗急性膝关节假体周围感染(periprosthetic joint infection,PJI)的临床疗效.[方法]回顾性分析2012年1月—2020年6月本院收治的21例(21...     

保留假体清创治疗急性假体周围感染

[目的]探讨保留假体清创治疗急性假体周围感染(PJI)的临床效果与炎性指标的早期变化.[方法]2010年1月～2017年8月,对28例髋/膝关节置换术后急性PJI患者采用保留假体清创联合抗生素治疗,设为感染组.随机选取同期初次髋/膝关节置换患者40例为非感染组.比较两组患者围手术期、随访与实验室检验结果.[结果]两组患...     

髋膝人工关节置换术后感染保留假体的清创治疗

目的 探讨人工髋、膝关节置换术后感染保留假体清创治疗的指征及注意事项.方法 回顾性分析自2004～2009年收治的7例髋、膝关节置换术后感染(髋3例,膝4例),经术前诊断、评估,行清创加术后抗生素抗感染的保留假体治疗,分析成功、失败原因.结果 7例中5例保留了假体,随访5～72个月,平均24.8个月,感染均无复发.2例...     

保留假体清创术治疗假体周围感染疗效的影响因素

假体周围感染(PJI)是人工关节置换术后的灾难性并发症,严重影响患者的生活质量,给家庭和社会造成了沉重的负担。保留假体的清创术由于创伤小、花费少,目前仍被推荐作为急性PJI的首选治疗。但文献报道的成功率差异极大,如何提高保留假体清创术的成功率,本文对该问题作一综述。     

清创保留假体治疗人工关节置换术后假体周围感染

<正>清创保留假体(debridement antibiotics irrigation and implant retention,DAIR)治疗人工关节置换术后假体周围感染(periprosthetic joint infection,PJI)创伤小,耗时短,技术水平要求相对低,是一种极具吸引力的治疗方法。通过DAIR成功治疗PJI后病人的患肢功能及生活质量都可以获得改善,与感染前比较有可比性[1]。然而,DAIR失败后的治疗往往需要多次     

全关节置换术后假体周围感染诊断的研究进展

假体周围感染是全关节置换术后最严重的并发症之一,诊断方法较多,但都缺乏特异性,本文就假体周围感染的临床症状、体征,实验室检查,影像学检查,特殊检查以及最新的研究进展进行综述。     

清创保留假体联合抗生素治疗膝关节置换术后急性感染

目的探讨采用清创保留假体联合抗生素(DAIR)治疗人工膝关节置换术后急性期感染的临床疗效。 方法回顾性分析解放军联勤保障部队第九四〇医院关节外科自2008年12月1日至2018年11月30日收治的,根据美国肌肉与感染协会(MSIS)诊断标准确诊为急性人工关节感染(PJI)的26例膝关节置换术后急性感染患者的临床资料。所有患者均采用一期彻底清创,更换膝关节聚乙烯衬垫,术后膝关节腔持续冲洗引流及足疗程敏感抗生素治疗。用t检验比较患膝术前、术后的膝关节疼痛视觉模拟评分(VAS评分),美国特种外科医院膝关节评分(HSS评分),入院及末次随访红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素-6(IL-6)。 结果纳入26例患者,失访3例,随访时间平均(44±28)个月。其中治愈17例,感染控制率73.9%。术后的膝关节VAS评分较术前降低(t＝24.815,P<0.05),术后的HSS评分较术前升高(t＝41.966,P<0.05)。末次随访ESR(t＝14.140)、CRP(t＝3.503)、IL-6(t＝2.999)均较入院时降低(均为P<0.05)。 结论DAIR治疗人工膝关节置换术后急性感染,严格把握手术时机及手术适应证,可有效控制感染,恢复关节功能,临床效果满意。     

全膝假体周围感染的清创抗生素假体保留治疗

[目的]探讨初次全膝置换术后假体周围感染（periprosthetic joint infection, PJI）的清创抗生素假体保留（debridement, antibiotics, and implant retention, DAIR）治疗的临床效果。[方法]回顾性分析2016年1月—2020年6月在本科采用DAIR治疗的33例初次全膝置换术后感染患者的临床资料,其中术后3个月内感染28例,术后4～6个月内感染5例。评价临床及检验结果。[结果]所有患者均顺利完成手术,手术时间平均（113.5±12.4） min,术中失血量平均（43.5±7.4） ml。随访（44.1±11.7）个月,28例手术成功,成功率84.8%;5例手术失败,其中初次置换术后3个月内感染2例,术后4～6个月内感染3例,失败率15.2%。与术前相比,末次随访时,患者疼痛VAS评分[(5.1±1.4),(1.4±0.9), P<0.001]显著降低,膝关节KSS功能评分[(43.0±9.9),(81.8±11.3), P<0.001]、KSS临床评分[(37.8±14.9),(84.0±7.0),...     

保留假体清创治疗人工膝关节置换术后感染的作用

[目的]探讨保留假体清创在治疗人工膝关节置换术后感染中的可行性、适应证、成功和失败的相关因素以及注意事项.[方法]回顾分析本院自1990～2004年收治的人工膝关节置换术后感染病例,发现9例病人在治疗开始时曾尝试采用清创灌注冲洗的方法保留假体,对这9例病人进行总结,并对可能影响清创是否成功的因素进行统计学分析.[结果]本组9例病人中4例保留了假体,平均随访18个月（10～25个月）,感染均无复发.由于病例数较少,本研究针对可能影响清创成功的因素未能得出有意义的统计学结果,但从结果看：急性感染清创容易成功,而慢性感染则很难获得成功;表皮葡萄球菌成功率较高,金黄色葡萄球菌均失败;表面膝置换成功率较高,而铰链膝置换则难以获得成功;出现症状后应该抓紧时间进行清创,延误的时间越长,成功的可能性越低.[结论]保留假体清创在人工膝关节置换术后感染的治疗中有一定的应用价值,对于术后急性感染病人和术后晚期急性血源性感染病人应尝试进行保留假体清创治疗,但必须严格掌握手术时机及适应证才能获得成功.     

An update on prosthetic joint infection for UK trainees

Prosthetic joint infection (PJI) is where a joint that has been replaced with an orthopaedic implant becomes infected. PJI is given special consideration because of difficulties in treatment and the potential for life- and limb-changing sequelae for patients. Management of PJI requires collaboration between multiple specialists and is best managed within a multidisciplinary team. This article provides an overview on the diagnosis and treatment of PJI. We have described clinical prediction rules used to aid diagnosis in challenging cases. We have outlined first-line treatment options (such as debridement, antibiotics and implant retention (DAIR) procedures, single-stage and two-stage revision surgery), and second-line treatments (including chronic antibiotic suppression and salvage procedures).     

Irrigation and Debridement in the Management of Prosthetic Joint Infection: Traditional Indications Revisited

Irrigation and debridement (I and D) is a procedure commonly used for the treatment of acute periprosthetic infection. This study retrospectively reviewed clinical records of patients with periprosthetic infection of the hip or knee who underwent I and D with retention of their prostheses between 1997 and 2005 at a single institution. One hundred four patients (44 males and 60 females) were identified. Mean age at time of initial debridement was 65 years. Average follow-up was 5.7 years. Treatment failure was defined as the need for resection arthroplasty or recurrent microbiologically proven infection. According to these criteria, I and D was successful in 46 patients (44%). Patients with staphylococcal infection, elevated American Society of Anesthesiologists score, and purulence around the prosthesis were more likely to fail. The high failure rate of this procedure implies that it should be preferably limited to select healthy patients with low virulence organisms and equivocal intraoperative findings.     

Good quality of life outcomes after treatment of prosthetic joint infection with debridement and prosthesis retention

Patients treated for early prosthetic joint infection (PJI) with surgical debridement and prosthesis retention have a rate of successful infection eradication that is similar to patients treated with the traditional approach of prosthesis exchange. It is therefore important to consider other outcomes after prosthetic joint infection treatment that may influence management decisions, such as quality of life (QOL). Our aim was to describe infection cure rates and quality of life for patients with prosthetic joint infection treated with debridement and prosthesis retention and to determine if treatment with this approach was a risk factor for poor quality of life outcomes. Prospectively collected pre and post‐arthroplasty data were available for 2,134 patients, of which PJI occurred in 41. For patients treated for prosthetic joint infection, the 2‐year survival free of treatment failure was 87% (95%CI 84–89). Prosthetic joint infection cases treated with debridement and retention had a similar improvement from pre‐arthroplasty to 12‐months post‐arthroplasty as patients without PJI in QOL according to the SF–12 survey. Prosthetic joint infection treated with debridement and retention was not a risk factor for poor quality of life on univariate or multivariate analysis. Prosthetic joint infection treated with debridement and prosthesis retention results in good cure rates and quality of life. Further studies are required that directly compare quality of life for different surgical approaches for prosthetic joint infection to better inform management decisions. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:898–902, 2016.     

A Multicenter Study of Irrigation and Debridement in Total Knee Arthroplasty Periprosthetic Joint Infection: Treatment Failure Is High

Background

In total knee arthroplasty (TKA) periprosthetic joint infection (PJI), irrigation and debridement (I&D) with component retention is a treatment option with a wide variation in reported failure rates. The purpose of this study was to determine failure rates, outcomes, and factors that predict failure in I&D for TKA PJI.

保留假体清创联合局部万古霉素治疗全膝关节置换术后早期感染

目的探讨保留假体清创联合局部关节腔注射万古霉素治疗人工全膝关节置换术后早期感染的临床疗效和可行性。方法回顾性分析2015年1月至2018年2月,我院人工全膝关节置换术后感染应用保留假体清创联合局部万古霉素治疗的24例临床资料,其中男性10例,女性14例;年龄56~79岁,平均(64.1±7.2)岁。外院感染22例,本院感染2例。病程12~28 d,平均(20.3±2.4)d。记录患者术前及末次随访的美国膝关节协会评分(knee society score,KSS)、美国特种外科医院(the hospital special surgery,HSS)膝关节评分、视觉模拟评分(visual analogue scale,VAS)、术后复发以及并发症情况,采用简易Likert量表法进行患者满意度评价。结果所有患者均获随访,随访时间8~41个月,平均(27.8±5.8)个月。手术成功率87.5%(21/24),术后并发症发生率16.7%(4/24)。本组病例术前KSS评分(52.3±9.8)分、HSS评分(54.7±10.3)分,末次随访分别为(83.4±18.0)分、(90.6±14.5)分,末次随访评分明显高于术前(P<0.05)。术前VAS评分为(6.3±1.8)分,末次随访降至(1.1±0.9)分,差异有统计学意义(P<0.05)。根据简易Liket量表,患者术后满意度为83.3%(20/24)。结论保留假体清创联合局部万古霉素治疗人工全膝关节术后早期感染是安全有效的,能够显著降低疼痛、提高膝关节功能,并有着较高的成功率及患者满意度,但远期疗效仍需进一步观察。     

Results of infected total knee arthroplasty treated with arthroscopic debridement and continuous antibiotic irrigation system

Background:

Arthroscopic debridement with continuous irrigation system was used with success in treating infective arthritis. We evaluated the effectiveness of arthroscopic debridement coupled with antibiotic continuous irrigation system in acute presentation of late infected total knee arthroplasty.

Materials and Methods:

We performed a retrospective review of medical record of patients with acute presentation of late infected total knee arthroplasty who were treated by arthroscopic debridement coupled with continuous postoperative antibiotic irrigation system.

Results:

Seventeen patients were included in our study. 15 (88%) patients preserved their total knee prosthesis at mean of followup of 27.5 months (range, 14-28 months). Two (12%) patients failed arthroscopic protocol and finally needed two stages revision. Our study showed an 88% prosthesis retention rate in patients with acute presentation of late prosthetic knee infection. No complication was associated with use of antibiotic irrigation system.

Conclusion:

Arthroscopic debridement combined with continuous antibiotic irrigation and suction is an effective treatment for patients with acute presentation of late infected total knee arthroplasty.     

Acceptable Success Rate in Patients With Periprosthetic Knee Joint Infection Treated With Debridement,Antibiotics, and Implant Retention

Background

Acute periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) surgery can be treated with debridement, antibiotics, and implant retention (DAIR). However, varying results have been reported in the literature and optimal timing of the procedure is still debated.In this retrospective cohort study, we investigate (a) success rate of DAIR for treating PJI following primary TKA surgery and (b) whether time after primary surgery until DAIR and (c) type of isolated microorganism influence outcome.

Utilization of Debridement,Antibiotics, and Implant Retention for Infection After Total Joint Arthroplasty Over a Decade in the United States

BackgroundReported clinical outcomes have varied for debridement, antibiotics, and implant retention (DAIR) and little is known regarding trends in utilization. We sought to evaluate the rate of DAIR utilization for total knee arthroplasty (TKA) and total hip arthroplasty (THA) periprosthetic joint infection (PJI) over a decade and clinical factors associated with these trends.MethodsA retrospective study of primary TKAs and THAs was performed using Medicare data from 2005 to 2014 using the PearlDiver database platform. Current Procedural Technology and International Classification of Diseases Ninth Edition codes identified patients who underwent a surgical revision for PJI, whether revision was a DAIR, as well as associated clinical factors including timing from index arthroplasty.ResultsThe proportion of revision TKAs and THAs performed using DAIR was 27% and 12% across all years, respectively. This proportion varied by year for TKAs and THAs with a linear trend toward increasing relative use of DAIR estimated at 1.4% and 0.9% per year (P < .001; P < .001). DAIR for TKA and THA performed within 90 days increased at a faster rate, 3.4% and 2.1% per year (P < .001; P < .001). Trends over time in TKA DAIRs showed an association with Elixhauser Comorbidity Index (ECI), 0-5 group increasing at 2.0% per year (P = .03) and patients >85 years (P = .04).ConclusionThe proportion of revision arthroplasty cases for PJI managed with DAIR has been increasing over time in the United States, with the most substantial increase seen <90 days from index arthroplasty. Age, gender, and ECI had a minimal association with this trend, except in the TKA population >85 years and in those with a very low ECI score.