Mittal Yogesh, Fehring Thomas K, Hanssen Arlen, Marculescu Camelia, Odum Susan M, Osmon Douglas
OrthoCarolina Hip and Knee Center, Charlotte, North Carolina 28270, USA.
J Bone Joint Surg Am. 2007 Jun;89(6):1227-31. doi: 10.2106/JBJS.E.01192.
Two-stage reimplantation is the most accepted mode of treatment for patients with a periprosthetic infection following total knee arthroplasty. Most studies, however, do not stratify their results on the basis of the type of infecting organism. The purpose of this study was to determine the outcomes for patients who had two-stage reimplantation for the treatment of infection with a resistant organism, methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis, at the site of a total knee replacement.
A multicenter study was performed to review the cases of all patients treated between 1987 and 2003 because of an infection with methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis organisms at the site of a total knee replacement. The prevalence of reinfection following two-stage reimplantation was determined. Variables that may influence the outcome, such as the duration and type of intravenous antibiotics administered, previous surgery, and comorbidities of the host, were analyzed.
We identified thirty-seven patients who had an infection with a resistant organism. All patients had negative cultures at the time of reimplantation. Four of the thirty-seven patients had a reinfection with the same organism, while five had a reinfection with a different organism. None of the variables noted above were found to be significantly associated with reinfection, on the basis of the numbers available.
Reports in the literature have discouraged reimplantation for the treatment of an infection with a resistant organism at the site of a total knee replacement. While 24% of the patients in this series had a reinfection, 14% had a reinfection with a different organism. We believe that two-stage reimplantation remains a viable treatment option for patients who have an infection with a resistant organism at the site of a total knee replacement.
Therapeutic Level IV.
两阶段再植入是全膝关节置换术后假体周围感染患者最常用的治疗方式。然而，大多数研究并未根据感染病原体的类型对结果进行分层。本研究的目的是确定在全膝关节置换部位因耐甲氧西林金黄色葡萄球菌或耐甲氧西林表皮葡萄球菌感染而接受两阶段再植入治疗的患者的治疗结果。
进行了一项多中心研究，以回顾1987年至2003年间所有因全膝关节置换部位耐甲氧西林金黄色葡萄球菌或耐甲氧西林表皮葡萄球菌感染而接受治疗的患者病例。确定两阶段再植入后再次感染的发生率。分析了可能影响结果的变量，如静脉使用抗生素的持续时间和类型、既往手术以及宿主的合并症。
我们确定了37例感染耐药菌的患者。所有患者在再植入时培养结果均为阴性。37例患者中有4例再次感染相同病原体，5例再次感染不同病原体。根据现有数据，未发现上述任何变量与再次感染有显著相关性。
文献报道不鼓励对全膝关节置换部位的耐药菌感染进行再植入治疗。虽然本系列中有24%的患者再次感染，但14%的患者再次感染不同病原体。我们认为，对于全膝关节置换部位感染耐药菌的患者，两阶段再植入仍然是一种可行的治疗选择。
治疗性IV级。
