Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of c...Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement(I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined,aggressive protocol is applied. In conclusion,when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.展开更多
Periprosthetic joint infection(PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing eff...Periprosthetic joint infection(PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively(4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one ormore positive culture results. Debridement, antibiotics and implant retention(DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus(aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one- or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients.展开更多
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...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。展开更多
目的探讨KLIC(kidney,liver,index surgery,cemented prosthesis and C reactive protein value)评分系统用于预测清创、假体保留联合抗生素方案(DAIR)治疗急性假体周围感染(PJI)结果的准确性。方法回顾性研究。纳入2015年1月—2020年1...目的探讨KLIC(kidney,liver,index surgery,cemented prosthesis and C reactive protein value)评分系统用于预测清创、假体保留联合抗生素方案(DAIR)治疗急性假体周围感染(PJI)结果的准确性。方法回顾性研究。纳入2015年1月—2020年12月南京大学医学院附属金陵医院骨科急性PJI患者44例,其中男17例、女27例,年龄21~86岁,均行DAIR。结合病史和检验结果,计算患者术前KLIC评分,并按评分结果将患者分为KLIC评分≤2分组、2.5~3.5分组、4~5分组、5.5~6.5分组和≥7分组。比较各组患者基线资料、住院时间和DAIR治疗结果的差异。采用受试者操作特征曲线(ROC)来评价KLIC评分系统预测DAIR治疗结果的准确性;以DAIR失败作为终点事件,采用Kaplan-Meier绘制累积治疗成功率曲线。结果5组患者年龄、性别、体质量指数(BMI)、病变部位、感染分类、感染症状持续时间、术后住院时间等基线资料比较,差异均无统计学意义(P值均>0.05)。5组患者总体治疗成功率为61.36%(27/44)、失败率为38.64%(17/44);KLIC评分≤2、2~3.5、4~5、5.5~6.5分和≥7分5组的失败率分别为0/8、2/8、5/13、6/10、4/5,组间比较差异有统计学意义(P=0.018);趋势χ^(2)检验结果提示,随着KLIC评分的增加,DAIR失败率也随之增加,差异有统计学意义(χ^(2)=10.86,P=0.001)。ROC曲线显示KLIC评分在预测DAIR治疗结果上具有较高的准确性(AUC=0.876,95%可信区间0.773~0.978,P<0.001)。Kaplan-Meier曲线提示:KLIC评分≥7分的患者累积治疗成功率低于KLIC评分<7分者,差异有统计学意义(χ^(2)=8.95,P=0.003)。结论KLIC评分对于DAIR治疗结果具有良好的预测性;对于KLIC评分≥7分的急性PJI患者,DAIR治疗的失败率较高,不建议采用。展开更多
文摘Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement(I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined,aggressive protocol is applied. In conclusion,when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.
文摘Periprosthetic joint infection(PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively(4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one ormore positive culture results. Debridement, antibiotics and implant retention(DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus(aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one- or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients.
文摘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。
文摘目的探讨KLIC(kidney,liver,index surgery,cemented prosthesis and C reactive protein value)评分系统用于预测清创、假体保留联合抗生素方案(DAIR)治疗急性假体周围感染(PJI)结果的准确性。方法回顾性研究。纳入2015年1月—2020年12月南京大学医学院附属金陵医院骨科急性PJI患者44例,其中男17例、女27例,年龄21~86岁,均行DAIR。结合病史和检验结果,计算患者术前KLIC评分,并按评分结果将患者分为KLIC评分≤2分组、2.5~3.5分组、4~5分组、5.5~6.5分组和≥7分组。比较各组患者基线资料、住院时间和DAIR治疗结果的差异。采用受试者操作特征曲线(ROC)来评价KLIC评分系统预测DAIR治疗结果的准确性;以DAIR失败作为终点事件,采用Kaplan-Meier绘制累积治疗成功率曲线。结果5组患者年龄、性别、体质量指数(BMI)、病变部位、感染分类、感染症状持续时间、术后住院时间等基线资料比较,差异均无统计学意义(P值均>0.05)。5组患者总体治疗成功率为61.36%(27/44)、失败率为38.64%(17/44);KLIC评分≤2、2~3.5、4~5、5.5~6.5分和≥7分5组的失败率分别为0/8、2/8、5/13、6/10、4/5,组间比较差异有统计学意义(P=0.018);趋势χ^(2)检验结果提示,随着KLIC评分的增加,DAIR失败率也随之增加,差异有统计学意义(χ^(2)=10.86,P=0.001)。ROC曲线显示KLIC评分在预测DAIR治疗结果上具有较高的准确性(AUC=0.876,95%可信区间0.773~0.978,P<0.001)。Kaplan-Meier曲线提示:KLIC评分≥7分的患者累积治疗成功率低于KLIC评分<7分者,差异有统计学意义(χ^(2)=8.95,P=0.003)。结论KLIC评分对于DAIR治疗结果具有良好的预测性;对于KLIC评分≥7分的急性PJI患者,DAIR治疗的失败率较高,不建议采用。
