Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1, Ohyaguchikamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
Knee Surg Sports Traumatol Arthrosc. 2011 Dec;19(12):2040-4. doi: 10.1007/s00167-011-1525-x. Epub 2011 May 4.
Total knee arthroplasty (TKA) has been proven to be the most effective treatment for patients with severe joint disease. Although infection is not a frequent complication, it is certainly one of the most dreaded. The purpose of this study was to identify factors associated with infection after TKA.
Between 1995 and 2006, 2,022 primary TKAs in 1,146 patients were evaluated. Flexible Nichidai Knee (FNK) was used as a prothesis in all subjects. Twenty-four patient-specific data items were collected via chart review for each patient. Revision arthroplasty procedures and infected knees were excluded. The medical records were reviewed to extract the following information: age, gender, body mass index (BMI), preoperative C-reactive protein (CRP), preoperative erythrocyte sedimentation rate (ESR), preoperative total protein (TP), duration of surgery, operative blood loss, total blood loss, duration of surgical drain, duration of antibiotic prophylaxis, primary diagnoses, smoking, diabetes mellitus, steroid or disease modifying anti-rheumatic drugs (DMARDs) therapy, previous operation around the knee joint, previous arthroscopic surgery, previous non-arthroscopic surgery, previous high tibial osteotomy (HTO) or open reduction internal fixation (ORIF), remnants of previous internal fixation material, bone graft, patella replacement, and bone cement.
The median age of the patients at the time of primary TKA was 72 (range, 26-91) years. The median follow-up period after primary TKA was 42 (range, 6-145) months. During the study period, 17 infected knee arthroplasties in 17 patients were identified. Previous history of ORIF, male gender, remnants of previous internal fixation material, and BMI showed significant correlation with postoperative infection.
This study identified previous history of fracture and remnants of internal fixation as major risk factors of infection after TKA. For clinical relevance, surgeons should be aware of potential infection when performing TKA in patients with these risk factors and patients should be informed of the potential risks.
全膝关节置换术（TKA）已被证明是治疗严重关节疾病患者的最有效方法。虽然感染不是常见的并发症，但肯定是最可怕的并发症之一。本研究旨在确定 TKA 后感染的相关因素。
1995 年至 2006 年间，对 1146 例患者的 2022 例初次 TKA 进行了评估。所有患者均使用 Flex 尼奇代膝（FNK）作为假体。通过图表回顾收集了 24 项患者特定的数据项。排除了翻修关节置换术和感染的膝关节。回顾病历以提取以下信息：年龄、性别、体重指数（BMI）、术前 C 反应蛋白（CRP）、术前红细胞沉降率（ESR）、术前总蛋白（TP）、手术时间、手术失血量、总失血量、引流管时间、抗生素预防时间、主要诊断、吸烟、糖尿病、皮质类固醇或疾病修饰抗风湿药物（DMARDs）治疗、膝关节周围既往手术、关节镜手术、非关节镜手术、高位胫骨截骨术（HTO）或切开复位内固定术（ORIF）、既往内固定材料残留、骨移植、髌骨置换、骨水泥。
初次 TKA 时患者的中位年龄为 72 岁（范围 26-91 岁）。初次 TKA 后中位随访时间为 42 个月（范围 6-145 个月）。研究期间，在 17 名患者的 17 个膝关节中发现了 17 个感染性膝关节置换。既往 ORIF 病史、男性、既往内固定物残留和 BMI 与术后感染显著相关。
本研究确定了既往骨折史和内固定物残留是 TKA 后感染的主要危险因素。从临床角度来看，当外科医生对有这些危险因素的患者进行 TKA 时，应意识到潜在的感染，并且应告知患者潜在的风险。
