Parvizi Javad, Zmistowski Benjamin, Adeli Bahar
Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Orthopedics. 2010 Sep 7;33(9):659. doi: 10.3928/01477447-20100722-42.
Periprosthetic joint infection has become the most common cause of failure following total knee arthroplasty. Over the past 4 decades, treatment of this disease has evolved with technological innovations and pathogen profiling. The appropriate treatment selection is dependent on patient immune system quality, timing of symptom onset, and pathogen type. Antibiotic suppression alone is reserved for those cases without drainage, low-virulent antimicrobial-susceptible pathogens, and patients whose level of health increases the risk of surgery past any risk associated with chronic infection. In patients with an acute onset of symptoms and antimicrobial-susceptible pathogens, irrigation and debridement with exchange of modular components is moderately successful and offers the advantage of component retention and maximum knee function. In failed irrigation or chronic periprosthetic joint infection, resection of all components is necessitated. Resection and reimplantation can either be performed in one or two stages. A single-stage exchange has the potential to decrease the number of surgeries and therefore cost. However, the success rate of direct exchange is lower than that of two-stage revision. This has led to two-stage revision, with the placement of an intra-stage antibiotic-loaded spacer, to become the "gold" standard for periprosthetic joint infection eradication. In an immunocompromised patient with an uncontrollable periprosthetic joint infection, salvage procedures are necessitated. Complete eradication of periprosthetic joint infection is achieved by resection of all components without reimplantation through arthrodesis or above-the-knee-amputation. While amputation may be unpopular with patients it provides a greater ability to reconstruct, with an external prosthesis, a functioning joint.
人工关节周围感染已成为全膝关节置换术后最常见的失败原因。在过去的40年里，随着技术创新和病原体分析，这种疾病的治疗方法不断发展。合适的治疗选择取决于患者的免疫系统质量、症状出现的时间以及病原体类型。仅抗生素抑制适用于那些无需引流、低毒且对抗生素敏感的病原体感染，以及健康状况使手术风险超过慢性感染相关风险的患者。对于症状急性发作且病原体对抗生素敏感的患者，进行冲洗清创并更换模块化组件的治疗方法有一定成功率，且具有保留组件和最大程度恢复膝关节功能的优势。对于冲洗失败或慢性人工关节周围感染，必须切除所有组件。切除和再植入可分一期或两期进行。一期置换有可能减少手术次数，从而降低成本。然而，直接置换的成功率低于两期翻修。这使得放置含抗生素的关节内间隔物的两期翻修成为根除人工关节周围感染的“金”标准。对于免疫功能低下且人工关节周围感染无法控制的患者，需要采取挽救性手术。通过切除所有组件且不再植入，采用关节融合术或大腿截肢术可实现人工关节周围感染的完全根除。虽然截肢可能不受患者欢迎，但它为使用外部假体重建功能关节提供了更大的可能性。
