Infection sur prothèse de la hanche : étude rétrospective multicentrique tunisienne à propos de 250 cas
Abstract
Abstract :
Introduction : Periprosthetic hip infection is a tragedy for both patients and surgeons. It represents the third cause prosthesis revision and increases patient morbidity and mortality, hospital stays, and healthcare costs. Treatment remains complex and poorly codified.
The target of this study is to analyze the current status of these infections in Tunisia and to evaluate management through a multicenter study.
Methods : This is a multicenter retrospective descriptive study (16 Tunisian public orthopedic surgery centers) involving 250 patients treated and followed for periprosthetic hip infections, over a period of 5 years from June 2018 to June 2023.
Results : At a mean follow-up of 23.6 months, infections were distributed according to the Tsukayama classification, into early in 109 patients (43.6%), chronic in 81 patients (32.4%) and acute hematogenous in 60 patients (24%). The infection was monomicrobial in 166 patients (74.8%) and polymicrobial in 56 patients (25.2%). Gram-positive cocci (GPC) infections were predominant (68.8%), Staphylococcus Aureus was the most frequently isolated germ (36.3%). The initial surgical approach was Debridement, Antibiotics and Implant Retention (DAIR) in 159 cases (63.6%), single-stage removal of the prosthesis was performed in 23 cases (9.2%) and two-stage removal in 46 cases (18.4%).
Conclusion : Periprosthetic infection represents a real diagnostic and therapeutic challenge for the patient's healthcare team. Management must be multidisciplinary, involving orthopedic surgeons, anesthesiologists, microbiologists, and infectious disease specialists, among others.
Résumé
Résumé :
Introduction : L’infection péri prothétique de la hanche est un drame pour le patient et pour le chirurgien. Elle représente la 3ème cause de révision de ces prothèses et augmente la morbi-mortalité des patients, la durée de l’hospitalisation et le cout des soins. Le traitement reste complexe et mal codifié.
L’objectif de ce travail est d’analyser l’état actuel de ces infections en Tunisie et d’évaluer la prise en charge à travers une étude multicentrique.
Matériel et méthodes : Il s’agit d’une étude descriptive rétrospective multicentrique (16 centres de chirurgie orthopédique publiques tunisiens) intéressant 250 patients traités et suivis pour des infections sur prothèse de la hanche de première intention, sur une période de 5 ans allant de Juin 2018 à Juin 2023.
Résultats : Les résultats ont été appréciés à un recul moyen de 23.6 mois. Selon la classification de Tsukayama, les infections étaient réparties en précoce chez 109 patients (43.6%), chronique chez 81 patients (32.4%) et aigue hématogène chez 60 patients (24%). L’infection était monomicrobienne chez 166 patients (74.8%) et polymicrobienne chez 56 patients (25.2%). Les infections à Cocci Gram positif (CGP) étaient prédominantes (68.8%), le Staphylocoque Aureus était le germe isolé le plus fréquent (36.3%). L’attitude chirurgicale initiale était un débridement -lavage et conservation de la prothèse (DAIR) dans 159 cas (63.6%), La dépose-repose de la prothèse en un seul temps a été effectuée dans 23 cas (9.2%) et la dépose-repose en deux temps dans 46 cas (18.4%). Le recours à la dépose sans repose a été adopté dans 22 cas (8.8%).
Conclusion : Chaque infection péri prothétique représente un véritable challenge diagnostique et thérapeutique pour l’équipe soignante en charge du patient. La prise en charge doit être multidisciplinaire, impliquant entre autres chirurgiens orthopédistes, anesthésistes réanimateurs, microbiologistes et infectiologues.
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