二期翻修术治疗感染性全膝关节置换术：失败的预测因素。
Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure.
机构信息
The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
出版信息
Clin Orthop Relat Res. 2011 Nov;469(11):3049-54. doi: 10.1007/s11999-011-2030-8.
BACKGROUND
In North America, a two-stage exchange arthroplasty remains the preferred surgical treatment for chronic periprosthetic joint infection (PJI). Currently, there are no proper indicators that can guide orthopaedic surgeons in patient selection for two-stage exchange or the appropriate conditions in which to reimplant.
QUESTIONS/PURPOSES: To identify (1) the rate of recurrent PJI after two-stage exchange and (2) the role of 15 presurgical and 11 operative factors in influencing the outcome of two-stage revision.
PATIENTS AND METHODS
From a prospective database we identified 117 patients who had undergone two-stage exchange arthroplasty for PJI of the knee from 1997 to 2007. Failure of two-stage revision was defined as any treated knee requiring further treatment for PJI. We identified 15 presurgical and 11 surgical factors that might be related to failure. Minimum followup was 2 years (average, 3.4 years; range, 2-9.4 years).
RESULTS
Thirty-three of 117 reimplantations (28%) required reoperation for infection. Age, gender, body mass index, and comorbidity indices were similar in both groups. Multivariate analysis provided culture-negative (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.3-15.7), methicillin-resistant organisms (OR, 2.8; 95% CI, 0.8-10.3), and increased reimplantation operative time (OR, 1.01; 95% CI, 1.0-1.03) as predictors of failure. ESR and CRP values at the time of reimplantation and time from resection to reimplantation were not predictors.
CONCLUSIONS
Our observations suggest the failure rate after two-stage reimplantation for infected TKA is relatively high. Culture-negative or methicillin-resistant PJI increases the risk of failure over four- and twofold, respectively. We identified no variables that would guide the surgeon in identifying acceptable circumstances in which to perform the second stage.
LEVEL OF EVIDENCE
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
在北美，双阶段关节置换术仍然是治疗慢性假体周围关节感染（PJI）的首选手术方法。目前，没有适当的指标可以指导骨科医生选择双阶段置换术或适当的条件重新植入。
问题/目的：确定（1）双阶段置换后 PJI 复发率，以及（2）15 个术前和 11 个手术因素在影响双阶段翻修结果中的作用。
患者和方法
我们从一个前瞻性数据库中确定了 1997 年至 2007 年间因膝关节 PJI 接受双阶段置换术的 117 名患者。双阶段翻修失败定义为任何需要进一步治疗 PJI 的治疗膝关节。我们确定了 15 个术前和 11 个手术因素可能与失败有关。最低随访时间为 2 年（平均 3.4 年；范围，2-9.4 年）。
结果
117 例再植入中有 33 例（28%）因感染需要再次手术。两组患者的年龄、性别、体重指数和合并症指数相似。多变量分析提供了阴性培养（优势比[OR]，4.5；95%置信区间[CI]，1.3-15.7）、耐甲氧西林的病原体（OR，2.8；95%CI，0.8-10.3）和增加的再植入手术时间（OR，1.01；95%CI，1.0-1.03）是失败的预测因素。再植入时的 ESR 和 CRP 值以及切除至再植入的时间不是预测因素。
结论
我们的观察结果表明，接受双阶段再植入治疗感染性 TKA 的失败率相对较高。阴性培养或耐甲氧西林的 PJI 使失败风险分别增加了 4 倍和 2 倍。我们没有发现任何可以指导外科医生识别可接受的第二阶段手术条件的变量。
证据水平
III 级，预后研究。有关证据水平的完整描述，请参见作者指南。
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