Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Shadyside Medical Building, 5230 Centre Avenue, Suite 415, Pittsburgh, PA 15232, USA.
Clin Orthop Relat Res. 2012 Oct;470(10):2737-45. doi: 10.1007/s11999-012-2322-7.
Treatment of chronic periprosthetic joint infections (PJIs) after TKA is limited to fusions, above-the-knee amputations (AKAs), revision TKA, and antibiotic suppression and is often based on the patient's medical condition. However, when both fusion and AKA are options, it is important to compare these two procedures with regard to function.
QUESTIONS/PURPOSES: Do patients receiving a knee fusion for PJI after TKA have better function compared to patients receiving an AKA?
We retrospectively reviewed patients who were eligible for either fusion or AKA after PJI TKA. Thirty-seven patients underwent a fusion for PJIs after TKA between 1999 and 2010. Nine patients died postoperatively and eight patients were lost to followup, leaving 20 patients. Patients completed a specialized questionnaire about their fusion, and functional capability was assessed by the SF-12. We compared fusions to a previously published group of six patients who underwent AKA for recurrent PJI after TKA.
For patients with fusion, community ambulators increased from five to 10 and nonambulators decreased from three to one. For patients with AKA, nonambulatory patients increased from zero to two, and community ambulators decreased from four to one. The SF-12 physical component summary measurements were higher for fusions (51) than for AKAs (26). The mental component summary was also higher in fusions (60) than in AKAs (44). Seventy percent of patients indicated they would undergo a fusion again instead of undergoing an amputation if they were presented with both options after undergoing their operation.
Patients receiving knee fusions for treating recurrent PJIs after TKA have better function and ambulatory status compared to patients receiving AKA.
Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
全膝关节置换术后慢性假体周围关节感染（PJI）的治疗方法仅限于融合、膝上截肢（AKA）、翻修 TKA 以及抗生素抑制，且通常基于患者的身体状况。然而，当融合和 AKA 均为可选方案时，比较这两种手术对于功能而言非常重要。
问题/目的：接受 TKA 后 PJI 融合治疗的患者与接受 AKA 的患者相比，功能是否更好？
我们回顾性地分析了适合融合或 AKA 治疗的 PJI 患者。1999 年至 2010 年间，37 例患者因 TKA 后 PJI 接受了融合手术。9 例患者术后死亡，8 例患者失访，最终纳入 20 例患者。患者完成了有关融合的专门问卷，SF-12 评估了他们的功能能力。我们将融合与先前发表的 6 例因 TKA 后复发性 PJI 接受 AKA 的患者进行了比较。
对于接受融合治疗的患者，社区步行者从 5 例增加到 10 例，非步行者从 3 例减少到 1 例。对于接受 AKA 的患者，非步行者从 0 例增加到 2 例，社区步行者从 4 例减少到 1 例。融合的 SF-12 身体成分综合评分（51）高于 AKA（26）。融合的心理成分综合评分（60）也高于 AKA（44）。70%的患者表示，如果在接受手术治疗后可以选择再次进行手术，他们会选择接受融合治疗，而不是接受截肢。
与接受 AKA 的患者相比，接受 TKA 后治疗复发性 PJI 的膝关节融合患者的功能和步行状态更好。
III 级，治疗研究。有关证据等级的完整描述，请参阅作者指南。
