The thorough debridement in two-stage revision surgery for treatment of infection after total hip arthroplasty

doi:10.3969/j.issn.2095-4344.2015.48.006

Abstract

Abstract:

BACKGROUND: Infection is the catastrophic complication after total hip arthroplasty, moreover, its diagnostic criteria has not been unified, and treatment options were also controversial. The removal of the focus of infection was complete or not determines whether the joint could be reconstructed and the joint function could be restored.
OBJECTIVE: To analyze the experience and efficacy of thorough debridement in two-stage revision surgery for treatment of infection after hip arthroplasty.
METHODS: Totally 23 (24 hips) patients with infection after hip arthroplasty were treated at the Department of Orthopedics, Nanjing General Hospital of Nanjing Military Area Command of PLA from August 2008 to January 2013. The diagnostic criteria were in line with consensus. The repair options defined as two phrases: the first phrase was thorough debridement plus antibiotic-containing bone cement implanted with intervals; the second phrase was joint reconstruction. If the infection persisted in interval, debridement could be repeated, and then underwent joint reconstruction after the thorough control of infection. Harris scores of hip function were determined after revision during follow-up. Infection control condition was evaluated.
RESULTS AND CONCLUSION: All the patients were followed up, ranged from 1 to 5 years. The Harris scores increased from an average of 36.5 (27-45 scores) before treatment to an average of 88.6 (76-98 scores) after treatment. There was no infection recurrence. Infection control rates reached to 100%. These results suggest that two-stage revision is an effective method for treatment of infection after total hip arthroplasty. Thorough debridement plays a crucial role, and it can effectively control infection recurrence, improve prosthesis stability, so as to reconstruct joint function.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

CLC Number:

R318

Guo Guo-dong, Fan Gen-tao, Guo Ting, Zhao Jian-ning, Sun Guo-jing . The thorough debridement in two-stage revision surgery for treatment of infection after total hip arthroplasty [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(48): 7741-7746.

Figures/Tables 1

References

[1] 陈园,刘绍武,张洪军,等.股骨头坏死的治疗进展[J].中国中西医结合外科杂志, 2011,17(4): 447-449.

[2] 林民贵,严芝敏,邓小波.人工髋关节置换术与内固定治疗高龄不稳定性股骨转子间骨折探讨[J].中国现代药物应用, 2015,9(13): 40-41.

[3] 李志辉,张亦工,王彦伟.人工髋关节置换术治疗高龄股骨颈骨折[J].中国骨与关节损伤杂志, 2012, 27(6): 515-516.

[4] 高广庭,潘士虎,吕占辉,等.全髋关节置换术治疗强直性脊柱炎髋关节强直患者的并发症以及预后探讨[J].中国医师进修杂志, 2014. 37(14): 19-21.

[5] 张东亮,刘军,田峥巍.髋关节置换术并发症原因分析及其防治分析[J].当代医学, 2012,18(2): 45.

[6] 刘建国,陈洪瑜,姜涛,等.全髋关节置换与内固定治疗股骨颈骨折临床疗效分析[J].中国骨与关节损伤杂志, 2005, 20(10): 652-654.

[7] 袁涛,翁文杰.人工髋关节翻修原因探析[J].国际骨科学杂志, 2008, 29(6): 407-408.

[8] Haddad FS, Muirhead-Allwood SK, Manktelow AR, et al. Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br. 2000;82(5): 689-694.

[9] 杜英勋,吴汝平,闫青,等.人工髋关节置换术后感染的危险因素与预防[J].中华医院感染学杂志, 2015,25(9): 2094-2096.

[10] 冯宗权,邹勇根,潘耀成.人工髋关节感染翻修的探讨[J].中国矫形外科杂志, 2014, 22(17): 1613-1615.

[11] 尹治军,康鹏德,全髋关节置换术后假体周围感染的诊断与治疗[J].中国矫形外科杂志, 2011, 19(21): 1800-1803.

[12] 郭国栋,褚立涛,郭亭,等.超声裂解法处理人工关节感染假体细菌培养敏感性与特异性的Meta分析[J].医学研究生学报,2012, 25(11):1168-1172.

[13] Borde JP, Häcker GA, Guschl S,et al. Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI((R)) cartridge system: a pilot study. Infection. 2015;43(5): 551-560.

[14] Saeed K, Ahmad-Saeed N. The impact of PCR in the management of prosthetic joint infections. Expert Rev Mol Diagn. 2015;15(7): 957-964.

[15] Haddad FS, Bridgens A. Infection following hip replacement: solution options. Orthopedics. 2008;31(9): 907-908.

[16] Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1): e1-e25.

[17] Borens O, Corvec S, Trampuz A. Diagnosis of periprosthetic joint infections. Hip Int. 2012;22 Suppl 8: S9-14.

[18] Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010;92(11): 2102-2109.

[19] 徐鸿尧, 赵建宁,包倪荣. 发射单光子计算机断层扫描在关节置换感染翻修中的应用价值[J]. 中国骨伤, 2015,28(3): 219-221.

[20] Jin H, Yuan L, Li C, et al. Diagnostic performance of FDG PET or PET/CT in prosthetic infection after arthroplasty: a meta-analysis. Q J Nucl Med Mol Imaging. 2014;58(1): 85-93.

[21] Subbiahdoss G, Kuijer R, Grijpma DW, et al. Microbial biofilm growth vs. tissue integration: "the race for the surface" xperimentally studied. Acta Biomater. 2009;5(5): 1399-1404.

[22] Bjarnsholt T, Tolker-Nielsen T, Givskov M, et al. Detection of bacteria by fluorescence in situ hybridization in culture-negative soft tissue filler lesions. Dermatol Surg. 2009; 35 Suppl 2: 1620-1624.

[23] Biswas S, Roy S, Banerjee J, et al. Hypoxia inducible microRNA 210 attenuates keratinocyte proliferation and impairs closure in a murine model of ischemic wounds. Proc Natl Acad Sci U S A. 2010; 107(15): 6976-6981.

[24] Lima AF, Costa LB, Silva JL, et al. Interventions for wound healing among diabetic patients infected with Staphylococcus aureus: a systematic review. Sao Paulo Med J. 2011;129(3): 165-170.

[25] Kingsley A, Lewis T, White R. Debridement and wound biofilms. J Wound Care. 2011; 20(6): 286.

[26] 徐元玲,王建东,蒋琪霞.慢性伤口细菌生物膜的临床识别和影响因素的研究进展[J].医学研究生学报, 2014, 27(12): 1337-1339.

[27] 郭国栋.人工关节置换后感染假体细菌生物膜检测方法研究进展[J].医学研究生学报, 2012, 25(4): 434-437.

[28] Cooper HJ, Della Valle CJ. The two-stage standard in revision total hip replacement. Bone Joint J. 2013;95-B(11 Suppl A): 84-87.

[29] Callaghan JJ, Katz RP, Johnston RC. One-stage revision surgery of the infected hip. A minimum 10-year followup study. Clin Orthop Relat Res. 1999;(369): 139-143.

[30] Wu CC, Chen WJ. One-stage revision surgery to treat hip infected nonunion after stabilization with a sliding compression screw. Arch Orthop Trauma Surg. 2003;123(8): 383-387.

[31] Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91(1): 128-133.

[32] Emerson RH Jr, Muncie M, Tarbox TR, et al. Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res. 2002;(404): 132-138.

[33] Park SJ, Song EK, Seon JK, et al. Comparison of static and mobile antibiotic-impregnated cement spacers for the treatment of infected total knee arthroplasty. Int Orthop. 2010; 34(8): 1181-1186.

[34] 王寿宇,吕德成.人工全髋关节置换术后感染的早期诊断与防治[J].中国医师进修杂志,2010,33(6): 54-55.

[35] 赵建宁,郭亭,周利武,等.颗粒骨打压植骨技术在治疗髋臼骨缺损中的应用[J].中国骨与关节损伤杂志,2006,21(5): 341-343.

[36] Wimmer MD, Randau TM, Deml MC, et al. Impaction grafting in the femur in cementless modular revision total hip arthroplasty: a descriptive outcome analysis of 243 cases with the MRP-TITAN revision implant. BMC Musculoskelet Disord. 2013;14: 19.

[37] Puhto AP, Puhto TM, Niinimäki TT, et al. Two-stage revision for prosthetic joint infection: outcome and role of reimplantation microbiology in 107 cases. J Arthroplasty. 2014;29(6): 1101-1104.