1 Duke University Hospital, DUMC, Durham, NC, USA.
2 Duke, Durham, NC, USA.
Foot Ankle Int. 2018 Nov;39(11):1266-1271. doi: 10.1177/1071100718786164. Epub 2018 Jul 4.
Acute hematogenous periprosthetic joint infection (PJI) is defined in the literature as infection diagnosed and treated within 2 to 4 weeks from the onset of symptoms. In total hip and knee arthroplasty, irrigation and debridement (I&D) and polyethylene exchange with component retention has been studied extensively. However, there is minimal literature evaluating this treatment method for PJI in total ankle arthroplasty (TAA). The purpose of this study was to evaluate both the clinical and patient-reported outcomes and survivorship of TAA acute hematogenous PJIs treated with I&D and polyethylene exchange.
A single-center, retrospective chart review of prospectively collected data in patients with TAA PJI who subsequently underwent I&D and polyethylene exchange with retention of metal components was conducted. The primary outcome was failure rate of I&D and polyethylene exchange, where failure was defined as subsequent removal of all components and 2-stage revision or arthrodesis. Patient-reported outcomes collected before primary arthroplasty, after primary arthroplasty, and after polyethylene exchange were also analyzed.
We identified 14 patients with acute hematogenous PJI who underwent I&D and polyethylene exchange with retention of metal components. The mean time from primary TAA to symptoms was 43 months (range 1-147 months). The average time from onset of symptoms to I&D and polyethylene exchange was 11.4 ± 5.6 days. The mean follow-up after this surgery was 2.8 ± 1.5 years. The long-term failure rate was 54%. The most common bacteria isolated in patients who failed was methicillin-resistant Staphylococcus aureus (MRSA). The most common bacteria isolated in patients who retained their implants was methicillin-sensitive Staphylococcus aureus (MSSA). Visual analog scale (VAS), Short Musculoskeletal Function Assessment (SMFA), Short Form-36 (SF-36), and American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale showed significant improvement when compared to preoperative scores in patients who retained their implants both after primary and after I&D and polyethylene exchange.
I&D and polyethylene exchange with retention of metal components has a long-term survivorship comparable to those reported in the total knee and total hip arthroplasty literature. Patient-reported outcomes after I&D and polyethylene exchange were comparable to those collected after primary arthroplasty in those patients who ultimately retained their implants. Two variables in this cohort that were associated with I&D and polyethylene exchange failure include time the patient was symptomatic prior to I&D as well as organism isolated on culture. With a failure rate of 54%, the authors recommend thorough evaluation on a case-by-case basis prior to indicating a patient for single-stage I&D with polyethylene exchange.
Level IV, case series.
急性血源性假体周围关节感染（PJI）在文献中被定义为在症状出现后 2 至 4 周内诊断和治疗的感染。在全髋关节和膝关节置换术中，已广泛研究了冲洗和清创术（I&D）以及保留组件的聚乙烯交换。然而，对于全踝关节置换术（TAA）中的 PJI，评估这种治疗方法的文献很少。本研究的目的是评估接受 I&D 和聚乙烯交换并保留金属部件的 TAA 急性血源性 PJI 的临床和患者报告的结果以及生存率。
对前瞻性收集的 TAA PJI 患者的病历进行单中心回顾性图表审查，这些患者随后接受 I&D 和保留金属部件的聚乙烯交换。主要结局是 I&D 和聚乙烯交换的失败率，失败定义为随后取出所有部件并进行两期翻修或融合。还分析了初次关节置换前、初次关节置换后和聚乙烯交换后的患者报告的结果。
我们确定了 14 例接受 I&D 和保留金属部件的聚乙烯交换的急性血源性 PJI 患者。从初次 TAA 到出现症状的平均时间为 43 个月（范围 1-147 个月）。从症状出现到 I&D 和聚乙烯交换的平均时间为 11.4±5.6 天。手术后的平均随访时间为 2.8±1.5 年。长期失败率为 54%。在失败的患者中最常见的分离细菌是耐甲氧西林金黄色葡萄球菌（MRSA）。在保留植入物的患者中最常见的分离细菌是甲氧西林敏感金黄色葡萄球菌（MSSA）。与初次手术前相比，保留植入物的患者的视觉模拟量表（VAS）、短肢肌肉骨骼功能评估（SMFA）、简化 36 项健康调查（SF-36）和美国矫形足踝协会（AOFAS）后足评分均有显著改善。
I&D 和保留金属部件的聚乙烯交换的长期生存率与全膝关节和全髋关节置换术文献报道的生存率相当。在最终保留植入物的患者中，I&D 和聚乙烯交换后的患者报告结果与初次关节置换后的结果相当。本队列中与 I&D 和聚乙烯交换失败相关的两个变量是患者在接受 I&D 之前出现症状的时间以及培养物中分离出的病原体。由于失败率为 54%，作者建议在指示患者进行单阶段 I&D 和聚乙烯交换之前，根据具体情况进行彻底评估。
IV 级，病例系列。
