Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia.
Department of Orthopaedic Surgery, Larkin Community Hospital, South Miami, Florida.
J Arthroplasty. 2018 Feb;33(2):515-520. doi: 10.1016/j.arth.2017.08.037. Epub 2017 Sep 5.
Chronic periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is most commonly addressed with a 2-stage exchange procedure. The purpose of this study is to examine the natural history of patients who have undergone prosthesis removal and spacer placement and evaluate risk factors for outcomes other than reimplantation.
Patients who underwent removal of an infected TKA and placement of an antibiotic spacer for PJI were identified in a Medicare database. Patients with a study outcome within 1 year were then identified: (1) in hospital mortality, (2) knee arthrodesis, (3) amputation, (4) repeat debridement procedure without reimplantation, and (5) reimplantation. Independent risk factors for these outcomes were evaluated with a multivariate logistic regression analysis.
A total of 18,533 patients were included. Within 1 year postoperatively, 691 patients (3.7%) died in a hospital setting, 852 patients (4.5%) underwent a knee arthrodesis, 574 patients (3.1%) underwent an amputation, 2683 patients (14.5%) underwent a repeat debridement procedure without being reimplanted, 2323 patients (12.5%) retained their spacer, and 11,420 patients (61.6%) underwent spacer removal and reimplantation within 1 year. Numerous independent patient-related risk factors for these outcomes were identified.
A large number of patients (38.4%) do not undergo reimplantation within 1 year of prosthesis removal and spacer placement. Outcomes after prosthesis removal and antibiotic spacer placement are variable, and there are several independent risk factors for such outcomes that may be used to develop and improve existing treatment strategies for patients presenting with chronic PJI after TKA.
全膝关节置换术后（TKA）慢性假体周围关节感染（PJI）最常采用两期置换手术治疗。本研究旨在研究行假体取出和抗生素 spacer 植入术的患者的自然病史，并评估除再植入以外的结局的风险因素。
在 Medicare 数据库中确定了 TKA 感染并接受抗生素 spacer 植入术治疗 PJI 的患者。然后在 1 年内识别出具有研究结局的患者：（1）院内死亡，（2）膝关节融合，（3）截肢，（4）未再植入而重复清创术，以及（5）再植入。采用多变量逻辑回归分析评估这些结局的独立风险因素。
共纳入 18533 例患者。术后 1 年内，691 例（3.7%）患者在医院死亡，852 例（4.5%）患者行膝关节融合术，574 例（3.1%）患者行截肢术，2683 例（14.5%）患者行未再植入而重复清创术，2323 例（12.5%）患者保留 spacer，11420 例（61.6%）患者在 1 年内行 spacer 取出和再植入术。确定了许多与这些结局相关的独立患者相关风险因素。
大量患者（38.4%）在假体取出和 spacer 植入后 1 年内未行再植入术。假体取出和抗生素 spacer 植入后的结局各不相同，存在多个与这些结局相关的独立风险因素，可用于为 TKA 后出现慢性 PJI 的患者制定和改进现有治疗策略。
