Klinger Hans-Michael, Spahn Gunter, Schultz Wolfgang, Baums Mike Herbert
Department of Orthopaedic Surgery, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
Knee Surg Sports Traumatol Arthrosc. 2006 May;14(5):447-53. doi: 10.1007/s00167-005-0664-3. Epub 2005 Aug 30.
Infection after total knee arthroplasty (TKA) can be a challenging and difficult problem to treat. In selected patients, knee arthrodesis is a well-recognized salvage procedure after infected TKA. The authors retrospectively reviewed their experience with this treatment option, presenting 20 patients (8 women, 12 men), performed between 1990 and 2002. The average age was 67 years (range: 47-81 years) and the mean number of previous surgical procedures was 6 (range: 4-11 procedures). There were multiple indications for knee arthrodesis, including extensive bone or soft tissue loss, poor bone stock, and recurring infections. One-stage fusion was done in 7 knees while, on the other 13, arthrodesis was performed as two-stage fusions. The average clinical follow-up was 4.5 years (range: 2-11 years). 18 of the 20 patients were interviewed and graded using the Visual Analogue Scale (VAS) for pain, the Short Form-36 Health Survey (SF-36), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire that has knee-related quality of life items. According to the VAS, the mean intensity was 3.4 points. 6 (33%) of the patients had no difficulty with the knee and 9 (50%) of them had mild or moderate difficulty. The SF-36 scores were similar to those for normative data for patients after TKA, with only the social functioning, role emotional, and physical functioning scores being lower and the role physical and social functioning scores being higher. Three of 20 fusions failed, whereas two knees became non-infected non-unions. In one, the knee infection persisted and required above-knee amputation. The two-stage arthrodesis gave the most predictable rate of fusion. Persistent infection and extensive bone stock losses led to failure even under the best circumstances. In our opinion, arthrodesis of the knee is a satisfactory salvage procedure following a failed TKA, and can provide reliable expectation for a stable, painless extremity for high-functioning patients who are able to walk.
全膝关节置换术（TKA）后感染是一个具有挑战性且难以治疗的问题。对于部分患者，膝关节融合术是感染性TKA后一种公认的挽救手术。作者回顾性分析了他们采用这种治疗方法的经验，介绍了1990年至2002年间接受手术的20例患者（8名女性，12名男性）。平均年龄为67岁（范围：47 - 81岁），既往手术平均次数为6次（范围：4 - 11次）。膝关节融合术有多种适应证，包括广泛的骨或软组织缺损、骨量差以及反复感染。7例膝关节采用一期融合，另外13例采用二期融合。平均临床随访时间为4.5年（范围：2 - 11年）。对20例患者中的18例进行了访谈，并使用视觉模拟量表（VAS）评估疼痛程度、简短健康调查问卷（SF - 36）以及包含膝关节相关生活质量项目的膝关节损伤和骨关节炎疗效评分（KOOS）问卷进行评分。根据VAS，平均强度为3.4分。6例（33%）患者膝关节无困难，9例（50%）有轻度或中度困难。SF - 36评分与TKA后患者的标准数据相似，仅社会功能、角色情感和身体功能评分较低，角色身体和社会功能评分较高。20例融合中有3例失败，2例膝关节形成未感染的骨不连。1例膝关节感染持续存在，需要进行大腿截肢。二期融合术的融合率最可预测。即使在最佳情况下，持续感染和广泛的骨量丢失也会导致手术失败。我们认为，膝关节融合术是失败的TKA后的一种令人满意的挽救手术，对于能够行走的高功能患者，可以为其提供稳定、无痛肢体的可靠预期。
