Tigani D, Trisolino G, Fosco M, Ben Ayad R, Costigliola P
Department of Orthopaedic Surgery, Santa Maria alle Scotte Hospital, Siena, Italy.
Knee. 2013 Jan;20(1):9-18. doi: 10.1016/j.knee.2012.06.004. Epub 2012 Jul 10.
Two-stage revision is the gold standard treatment of TKA infection; nevertheless various factors may influence the success rate. The aim of our study was to assess the impact of the number of patient comorbidities together with virulence of infectious organism on prognosis of two-stage revision procedure in chronic peri-prosthetic knee infection; moreover we tried to demonstrate correlation between the presence of positive culture during re-implantation and re-infection rate.
Thirty-eight cases of two-staged revision procedures for infected total knee arthroplasty were prospectively followed. The presence of high virulence microorganisms on the culture result and the number (more than three) of comorbidities were used as major risk factors. All cases were divided into three groups: Group 1 (10 patients without major risk factors), Group 2 (18 patients with only one major risk factor), Group 3 (10 patients with both of major risk factors).
After a mean follow-up of 65months (range 24-139months), there was infection recurrence in nine cases: four re-infections occurred with the same organism while five patients had re-infection with a different organism. Recurrence was higher in Group 3 (33% of the cases), lower in Group 2 (12% of the cases), whereas no infection occurred in Group 1. Finally in case of positive intraoperative cultures recurrence rate was 83%, whereas when specimens were negative we had only 12.5% of re-infections.
Even if standard protocol of two-stage revision has demonstrated good results when treating low-virulence infections or patients without associated risk factors, its application to more challenging condition cannot be assumed.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.
两阶段翻修术是全膝关节置换术（TKA）感染的金标准治疗方法；然而，多种因素可能会影响成功率。我们研究的目的是评估患者合并症数量以及感染病原体的毒力对慢性人工膝关节周围感染两阶段翻修手术预后的影响；此外，我们试图证明再次植入时培养阳性与再感染率之间的相关性。
对38例感染性全膝关节置换术的两阶段翻修手术病例进行前瞻性随访。将培养结果中高毒力微生物的存在以及合并症数量（超过三种）用作主要危险因素。所有病例分为三组：第1组（10例无主要危险因素的患者），第2组（18例仅有一个主要危险因素的患者），第3组（10例有两个主要危险因素的患者）。
平均随访65个月（范围24 - 139个月）后，有9例出现感染复发：4例再次感染为同一病原体，而5例患者再次感染为不同病原体。第3组的复发率较高（占病例的33%），第2组较低（占病例的12%），而第1组未发生感染。最后，术中培养阳性时复发率为83%，而标本为阴性时再感染率仅为12.5%。
即使两阶段翻修的标准方案在治疗低毒力感染或无相关危险因素的患者时已显示出良好效果，但不能认为其适用于更具挑战性的情况。
IV级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
