Two-Stage Debridement With Prosthesis Retention for Acute Periprosthetic Joint Infections.

Autor: Chung AS; Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ., Niesen MC; Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ., Graber TJ; Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ., Schwartz AJ; Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ., Beauchamp CP; Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ., Clarke HD; Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ., Spangehl MJ; Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2019 Jun; Vol. 34 (6), pp. 1207-1213. Date of Electronic Publication: 2019 Feb 16.
DOI: 10.1016/j.arth.2019.02.013
Abstrakt: Background: Historically, infection control rates with debridement and component retention have been poor in the management of acute prosthetic joint infections. We previously described a 2-stage debridement with prosthesis retention protocol for acute periprosthetic joint infection and reported a 90% success rate in a sample of 20 patients.
Methods: A retrospective review of 83 patients who underwent a 2-stage debridement with implant retention with a minimum 1-year follow-up was performed. Patient data were primarily analyzed to determine infection control rates. Infections were considered controlled when patients had not undergone a reoperation for infection, and demonstrated lack of any clinical signs or symptoms of infection (a well healed wound, diminishing swelling and warmth, absence of erythema, improvement in baseline pain symptoms) A secondary goal of this study was to examine the effects of symptom duration on infection control rate.
Results: Average patient follow-up was 41.8 months (range 12-171) for all patients. The overall protocol success rate was 86.7% (72/83): 82.9% in hips and 89.6% in knees. Additionally, protocol success was observed in 45 of 48 primary joints (93.8%) and 27 of 35 (77.1%) revision joints (P = .046). Average time from onset of symptoms to surgery was 6.2 days for successfully treated patients (range 0-27 days) compared to 10.7 days for those who failed treatment (range 1-28 days, P = .070).
Conclusion: This 2-stage retention protocol resulted in a higher likelihood of infection control compared to prior reports of single stage debridement and modular part exchange.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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