Efficacy of debridement for early prosthetic joint infection following revision surgery
Objective:To analyze the clinical efficacy of debridement,antibiotics and implant retention(DAIR)combined with intra-articular antibiotic administration in the management of early prosthetic joint infection(PJI)following revision infection.Methods:A retrospective analysis of clinical data of 104 patients with early PJI treated with DAIR combined with intra-articular antibiotic administration at the First Affiliated Hospital of Xinjiang Medical University from January 2011 to December 2020.Patients were divided into revision arthroplasty group(25 cases)and primary arthroplasty group(79 cases)based on their surgical history.Baseline characteristic,including age,gender,infection site,body mass index(BMI),erythrocyte sedimentation rate(ESR),or C reactive protein(CRP)levels,were comparable between the two groups.Treatment success rates,pathogens,the Knee Society Score(KSS),the Harris Hip Score(HHS),and postoperative complications were compared between the two groups.Results:The revision surgery group had a follow-up period ranging from 0.3 to 127.0 months,with an average of(51.9±43.7)months,while the primary surgery group had a follow-up period ranging from 0.6 to 131.0 months,with an average of(63.5±40.0)months.At the final follow-up,the treatment success rate was significantly lower in the revision surgery group(56.0%,14/25)compared to the primary surgery group(86.1%,68/79)(P<0.05).In the revision surgery group,the cure rate for PJI was significantly higher in patients with a single revision(75%,12/16)compared to those with multiple(≥2)revisions(22.2%,2/9)(P<0.05).There was no statistically significant difference in the success rate for S.aureus infection between the revision(71.4%)and the primary(82.4%)surgery groups(P>0.05).The KSS and HHS in the revision surgery group improved from(36.2±8.1)and(41.4±6.5)preoperatively to(64.7±11.7)and(70.7±11.1)postoperatively,respectively(both P<0.001).In the primary surgery group,the KSS and HHS improved from(39.4±7.6)and(44.0±7.2)preoperatively to(80.2±8.2)and(81.7±6.7)postoperatively,respectively(both P<0.001).The postoperative KSS and HHS in the revision surgery group were significantly lower than those in the primary surgery group(both P<0.05).The incidence of postoperative complications was higher in the revision surgery group(56.0%,14/25)compared to the primary surgery group(24.1%,19/79)(P<0.05).Conclusions:DAIR is less effective in treating early PJI in patients with a history of revision surgery.DAIR is not recommended for treating early PJI with multiple(≥2)prior revision surgeries.
RevisionPrimaryEarlyProsthetic Joint InfectionDebridement with Implant Retention
NETL
NSTL
万方数据
