Teo Bryon Jun Xiong, Yeo William, Chong Hwei-Chi, Tan Andrew Hwee Chye
1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
2 Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
J Orthop Surg (Hong Kong). 2018 May-Aug;26(2):2309499018785647. doi: 10.1177/2309499018785647.
Surgical site infection (SSI) is a serious complication following total knee arthroplasty (TKA) leading to considerable morbidity. The incidence is reported to be up to 2%. Risk factors continue to be an area of intense debate. Our study aims to report the incidence of SSI and identify possible risk factors in our patients undergoing TKA.
Prospectively collected data for 905 patients who underwent elective unilateral TKA by a single surgeon from February 2004 to July 2014 were reviewed. Patient demographics and relevant co-morbidities such as diabetes and heart disease were analysed. The presence of superficial wound infections and/or prosthetic joint infections was included.
The overall infection rate was 1.10% (10 of 905 patients). Six patients (0.66%) were diagnosed with superficial infections and four with PJI (0.44%). The mean operative duration for TKA with SSI was significantly longer at 90.5 ± 28.2 min, compared to 72.2 ± 20.3 min in TKA without SSI ( p = 0.03). All superficial infections occurred within the first month post-surgery and were self-limiting with oral antibiotics. The four patients with PJI required repeated procedures following TKA, including debridement, implant removal and/or revision arthroplasty. None of the 10 patients had a history of diabetes. There were no significant differences in demographics and co-morbidities between those who developed infection after TKA and those who did not.
An overwhelming majority had good outcomes with only four deep infections resulting in revision surgery. We report that the risk of infection in TKA was significantly associated with a longer operative duration.
手术部位感染（SSI）是全膝关节置换术（TKA）后一种严重的并发症，会导致相当高的发病率。据报道，其发生率高达2%。危险因素仍然是一个激烈争论的领域。我们的研究旨在报告SSI的发生率，并确定我们接受TKA手术患者中可能的危险因素。
回顾性分析了2004年2月至2014年7月由一名外科医生进行择期单侧TKA手术的905例患者的前瞻性收集数据。分析了患者的人口统计学特征和相关合并症，如糖尿病和心脏病。记录是否存在浅表伤口感染和/或人工关节感染。
总体感染率为1.10%（905例患者中有10例）。6例患者（0.66%）被诊断为浅表感染，4例为假体周围感染（PJI，0.44%）。发生SSI的TKA手术平均持续时间明显更长，为90.5±28.2分钟，而未发生SSI的TKA手术平均持续时间为72.2±20.3分钟（p = 0.03）。所有浅表感染均发生在术后第一个月内，口服抗生素后可自愈。4例PJI患者在TKA术后需要重复手术，包括清创、植入物取出和/或关节置换翻修术。1组10例患者均无糖尿病病史。TKA术后发生感染的患者与未发生感染的患者在人口统计学特征和合并症方面无显著差异。
绝大多数患者预后良好，只有4例深部感染导致翻修手术。我们报告TKA感染风险与手术时间延长显著相关。
