N.N. Priorov Journal of Traumatology and OrthopedicsN.N. Priorov Journal of Traumatology and OrthopedicsВестник травматологии и ортопедии им. Н.Н. Приорова0869-86782658-6738Eco-Vector63394910.17816/vto633949Original study articlesОригинальные исследованияResearch ArticleMiddle-term two-stage treatment results of fistulous and non-fistulous form of chronic hip periprosthetic joint infectionСреднесрочные результаты двухэтапного лечения пациентов со свищевой и несвищевой формой хронической перипротезной инфекции тазобедренного суставаhttps://orcid.org/0000-0001-8573-10963717-1640KochishAndrey A.КочишАндрей Александрович
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

kochishman@gmail.comhttps://orcid.org/0000-0002-2083-24243086-3694BozhkovaSvetlana A.БожковаСветлана Анатольевна
Russian Federation

MD, Dr. Sci. (Medicine), professor

д-р мед. наук, профессор

clinpharm-rniito@yandex.ruhttps://orcid.org/0000-0002-5087-60817412-5114ArtyukhVasily A.АртюхВасилий Алексеевич
Russian Federation

MD, Dr. Sci. (Medicine)

д-р мед. наук

artyukhva@mail.ruVreden National Medical Research Center of Traumatology and OrthopedicsНациональный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена28102024251220243144955053006202408082024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0/https://journals.eco-vector.com/0869-8678/article/view/633949

BACKGROUND: Chronic deep periprosthetic infections (PPIs) of the hip joint are a major concern in modern orthopedic surgery. Numerous risk factors are being studied to reduce the recurrence rate; however, the role of functional fistulous tracts remains unclear.

AIM: To compare the physical status of patients, infection etiology, efficacy of chronic periprosthetic hip joint infection therapy, and treatment outcomes depending on the presence of a fistulous tract.

MATERIALS AND METHODS: The retrospective analysis included 218 patients, with two study groups. Group 1 had 80 PPI patients without fistulas, while Group 2 had 138 PPI patients with fistulas. Treatment outcomes were assessed in 202 patients; the median duration of follow-up was 26 months.

RESULTS: Patients with fistulas were younger than those without fistulas: 58 and 63 years, respectively (p = 0.006). There were no significant intergroup differences in the total comorbidity score, duration of surgery, and blood loss. Patients with fistulas had a three-day shorter average hospital stay than those without fistulas (p=0.03). Monobacterial PPIs were the most common in both groups, with Staphylococcus epidermidis predominating in the group without fistulas and Staphylococcus aureus in the group with fistulas (p <0.001). These findings had no significant impact on the recurrence rate. The efficacy of the first debridement was 82% and 76% in the groups without fistulas and with fistulas, respectively; the efficacy of the second debridement was 69% and 58%, respectively (p >0.05). The presence of a fistulous tracts significantly increased the risk of PPI recurrence (p=0.048).

CONCLUSION: PPIs of the hip joint with fistulas have no significant impact on the first PPI relapse; however, fistulas may significantly increase the risk of the second relapse. This must be taken into account when planning relapsing PPI treatment stages.

Обоснование. Хроническая глубокая перипротезная инфекция (ППИ) тазобедренного сустава остаётся актуальной проблемой современной ортопедии. С целью снижения частоты рецидивов изучаются многочисленные факторы риска, среди которых роль функционирующего свищевого хода остаётся неясной.

Цель. Провести сравнительный анализ соматического статуса пациентов, этиологии инфекционного процесса, эффективности лечения хронической перипротезной инфекции тазобедренного сустава и его исходов в зависимости от наличия свищевого хода.

Материалы и методы. В ретроспективный анализ включены 218 пациентов и сформированы две группы сравнения — 80 с несвищевой формой (НСФ) и 138 — со свищевой формой (СФ) ППИ. Результаты лечения оценены у 202 пациентов с медианой наблюдения 26 месяцев.

Результаты. Пациенты с СФ оказались моложе пациентов без свищей — 58 и 63 года соответственно, p=0,006. Суммарный балл коморбидности, длительность операции и кровопотеря в группах сравнения значимо не различались. Срок госпитализации в отделении для пациентов со свищами оказался меньше такового для пациентов без свищей в среднем на 3 дня (p=0,03). Монобактериальная форма ППИ преобладала в обеих группах сравнения с превалированием эпидермального стафилококка в группе НСФ и золотистого стафилококка в группе СФ (p <0,001) без значимого влияния на рецидив. Эффективность первой санации составила 82% для НСФ и 76% для СФ, второй санации — 69 и 58% соответственно (p >0,05). Свищевой ход статистически значимо увеличивал вероятность развития повторного рецидива ППИ (p=0,048).

Заключение. Свищевая форма хронической ППИ тазобедренного сустава не оказывает существенного влияния на развитие первого рецидива ППИ, однако может значительно увеличивать частоту развития второго рецидива. Данное обстоятельство необходимо учитывать при планировании этапного лечения рецидивирующей формы ППИ.

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