AIMS Periprosthetic joint infections (PJIs) with prior multiple failed surgery for reinfection represent a huge challenge for surgeons because of poor vascular supply and biofilm formation. This study aims to determine the results of single-stage revision using intra-articular antibiotic infusion in treating this condition. METHODS A retrospective analysis included 78 PJI patients (29 hips; 49 knees) who had undergone multiple prior surgical interventions. Our cohort was treated with single-stage revision using a supplementary intra-articular antibiotic infusion. Of these 78 patients, 59 had undergone more than two prior failed debridement and implant retentions, 12 patients had a failed arthroplasty resection, three hips had previously undergone failed two-stage revision, and four had a failed one-stage revision before their single-stage revision. Previous failure was defined as infection recurrence requiring surgical intervention. Besides intravenous pathogen-sensitive agents, an intra-articular infusion of vancomycin, imipenem, or voriconazole was performed postoperatively. The antibiotic solution was soaked into the joint for 24 hours for a mean of 16 days (12 to 21), then extracted before next injection. Recurrence of infection and clinical outcomes were evaluated. RESULTS A total of 68 patients (87.1%) were free of infection at a mean follow-up time of 85 months (24 to 133). The seven-year infection-free survival was 87.6% (95% confidence interval (CI) 79.4 to 95.8). No significant difference in infection-free survival was observed between hip and knee PJIs (91.5% (95% CI 79.9 to 100) vs 84.7% (95% CI 73.1 to 96.3); p = 0.648). The mean postoperative Harris Hip Score was 76.1 points (63.2 to 92.4) and Hospital for Special Surgery score was 78. 2 (63.2 to 92.4) at the most recent assessment. Polymicrobial and fungal infections accounted for 14.1% (11/78) and 9.0% (7/78) of all cases, respectively. CONCLUSION Single-stage revision with intra-articular antibiotic infusion can provide high antibiotic concentration in synovial fluid, thereby overcoming reduced vascular supply and biofilm formation. This supplementary route of administration may be a viable option in treating PJI after multiple failed prior surgeries for reinfection. Cite this article: Bone Joint J 2022;104-B(7):867-874.

中文翻译：

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在多次失败的假体周围感染手术后使用关节内抗生素输注进行有效的单期翻修：平均七年的随访。

AIMS 由于血管供应和生物膜形成不良，先前多次失败的再感染手术的假体周围感染 (PJI) 对外科医生来说是一个巨大的挑战。本研究旨在确定使用关节内抗生素输注单期翻修治疗这种情况的结果。方法 回顾性分析包括 78 名 PJI 患者（29 髋；49 膝），他们曾接受过多次手术干预。我们的队列使用补充关节内抗生素输注进行单期翻修治疗。在这 78 名患者中，59 名之前经历过两次以上失败的清创和植入物保留，12 名患者的关节成形术切除失败，3 名髋部之前经历过失败的二期翻修，其中四人在单阶段修订之前的一阶段修订失败。先前的失败被定义为需要手术干预的感染复发。除了静脉注射病原体敏感药物外，术后还进行了万古霉素、亚胺培南或伏立康唑的关节内输注。抗生素溶液在关节中浸泡 24 小时，平均 16 天（12 至 21 天），然后在下次注射前提取。评估了感染的复发和临床结果。结果共有 68 名患者（87.1%）在平均 85 个月的随访时间（24 至 133 个月）中没有感染。七年无感染生存率为 87.6%（95% 置信区间 (CI) 79.4 至 95.8）。髋关节和膝关节 PJI 的无感染生存率没有显着差异（91.5%（95% CI 79.9 至 100）与 84.7%（95% CI 73. 1 至 96.3); p = 0.648）。在最近一次评估中，术后平均 Harris 髋关节评分为 76.1 分（63.2 至 92.4），特殊外科医院评分为 78. 2（63.2 至 92.4）。多种微生物和真菌感染分别占所有病例的 14.1% (11/78) 和 9.0% (7/78)。结论 关节内抗生素输注单阶段翻修可提供高浓度的滑液抗生素，从而克服血管供应减少和生物膜形成的问题。这种补充给药途径可能是在多次失败的再感染手术后治疗 PJI 的可行选择。引用这篇文章：骨关节 J 2022;104-B(7):867-874。4) 在最近的评估中。多种微生物和真菌感染分别占所有病例的 14.1% (11/78) 和 9.0% (7/78)。结论 关节内抗生素输注单阶段翻修可提供高浓度的滑液抗生素，从而克服血管供应减少和生物膜形成的问题。这种补充给药途径可能是在多次失败的再感染手术后治疗 PJI 的可行选择。引用这篇文章：骨关节 J 2022;104-B(7):867-874。4) 在最近的评估中。多种微生物和真菌感染分别占所有病例的 14.1% (11/78) 和 9.0% (7/78)。结论 关节内抗生素输注单阶段翻修可提供高浓度的滑液抗生素，从而克服血管供应减少和生物膜形成的问题。这种补充给药途径可能是在多次失败的再感染手术后治疗 PJI 的可行选择。引用这篇文章：骨关节 J 2022;104-B(7):867-874。从而克服血管供应减少和生物膜形成。这种补充给药途径可能是在多次失败的再感染手术后治疗 PJI 的可行选择。引用这篇文章：骨关节 J 2022;104-B(7):867-874。从而克服血管供应减少和生物膜形成。这种补充给药途径可能是在多次失败的再感染手术后治疗 PJI 的可行选择。引用这篇文章：骨关节 J 2022;104-B(7):867-874。