Klatte T O, Schneider M M, Citak M, Oloughlin P, Gebauer M, Rueger M, Gehrke T, Kendoff D
Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767 Hamburg, Germany.
Knee. 2013 Jun;20(3):177-80. doi: 10.1016/j.knee.2013.02.004. Epub 2013 Mar 27.
Prior knee surgery in the setting of knee arthroplasty (KA) can influence the overall outcome of the procedure and render the operation more technically challenging. The effects of residual fixation devices on subsequent procedures about the knee are ill-defined. Some authors claim an increase in periprosthetic infection in this cohort of patients. The objective of this study was to evaluate the overall incidence of periprosthetic infections in patients undergoing primary KA with pre-existing osteosynthetic hardware in situ.
The current investigators retrospectively reviewed 124 patients undergoing knee arthroplasty and removal of orthopaedic fixation devices, due to prior high tibial osteotomies, fracture fixation or cruciate ligament reconstruction. The exclusion criterion was a prior history of infection of the fixation device. The mean follow-up time was 5.4 years (range 15 months to 9 years). Nine patients were lost to follow-up.
Joint aspiration was performed two weeks prior to surgery in 53 patients (42.4%) and intra-operative samples were obtained in 106 patients (84.8%), which did not show any bacterial growth. A subacute periprosthetic infection occurred after seven months in only one patient.
The results of the current study demonstrate that previously implanted osteosynthetic fixation devices do not significantly increase the risk of developing periprosthetic knee infections. A two-stage procedure with implant retrieval prior to total knee arthroplasty is not clinically indicated in the cohort described, amongst whom an infection rate of 0.9% was revealed.
膝关节置换术（KA）背景下既往的膝关节手术会影响该手术的整体效果，并使手术在技术上更具挑战性。残留固定装置对后续膝关节手术的影响尚不明确。一些作者声称该类患者假体周围感染会增加。本研究的目的是评估原位存在骨科内固定器械的初次膝关节置换术患者假体周围感染的总体发生率。
本研究的研究者回顾性分析了124例因既往高位胫骨截骨术、骨折固定或交叉韧带重建而接受膝关节置换术及取出骨科固定装置的患者。排除标准为固定装置既往有感染史。平均随访时间为5.4年（范围15个月至9年）。9例患者失访。
53例患者（42.4%）在手术前两周进行了关节穿刺，106例患者（84.8%）术中取了样本，均未显示有细菌生长。仅1例患者在7个月后发生了亚急性假体周围感染。
本研究结果表明，先前植入的骨科内固定装置不会显著增加发生假体周围膝关节感染的风险。在所述队列中，全膝关节置换术前进行取出植入物的两阶段手术并无临床指征，该队列的感染率为0.9%。
