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Abstract：
Periprosthetic joint infections (PJI) are among the most difficult complications to treat in orthopaedic surgery. Debridement, antibiotics, and implant retention (DAIR) represent an efficient strategy for acute PJI, especially when resorbable local antibiotic carriers and coatings are used. The aim of this pilot study was to evaluate the difference between using antibiotic-loaded hydrogel (ALH) and calcium sulphate (CS) beads in the DAIR procedure. We analysed 16 patients who had been treated since 2018 for acute PJI, namely eight patients with knee PJI (50%), seven with hip PJI (43.7%), and one with shoulder PJI (6.2%). Nine patients were treated with the Debridement, Antibiotic Coating and Retention of the Implant (DACRI) method, while seven were treated with the Debridement, Antibiotic Pearls, Retention of the Implant (DAPRI) method. We found no significant differences between the two groups in terms of age, sex, the American Society of Anesthesiologists risk score, Charlson Comorbidity Index, localisation, days from onset to diagnosis and pathogenesis. Furthermore, no differences were found between the DACRI and DAPRI groups in terms of infection control (15 patients, 93.75% with p = 0.36) and last C-Reactive Protein values (p = 0.26), with a mean follow-up of 26.1 ± 7.7 months. Treatment for one patient affected by knee Candida albicans PJI in the DACRI group was not successful. In conclusion, DAPRI and DACRI appear to be safe and effective treatments for PJIs. This evidence will encourage the development of new clinical research into local carriers and coatings for use in acute implant-associated infections.
摘要：
假体周围关节感染（PJI）是骨科手术中最难治疗的并发症之一。清创术,抗生素,植入物固位(DAIR)代表了急性PJI的有效策略，特别是当使用可吸收的局部抗生素载体和涂层时。这项初步研究的目的是评估在DAIR程序中使用负载抗生素的水凝胶（ALH）和硫酸钙（CS）珠之间的差异。我们分析了自2018年以来接受急性PJI治疗的16例患者，即8例膝关节PJI患者（50%），7名髋部PJI患者（43.7%），和一个与肩膀PJI（6.2％）。9名患者接受了清创术治疗，植入物的抗生素涂层和保留（DACRI）方法，虽然有7人接受了清创术治疗，抗生素珍珠，植入物的保留(DAPRI)方法。我们发现两组在年龄方面没有显着差异，性别,美国麻醉医师协会风险评分，Charlson合并症指数，本地化,从发病到诊断和发病的天数。此外，在感染控制方面，DACRI和DAPRI组之间没有发现差异(15例患者，93.75％，p=0.36）和最后的C反应蛋白值（p=0.26），平均随访26.1±7.7个月。DACRI组一名膝关节白色念珠菌PJI患者的治疗不成功。总之,DAPRI和DACRI似乎是PJIs安全有效的治疗方法。这些证据将鼓励开发用于急性植入物相关感染的局部载体和涂层的新临床研究。
