Gathen Martin, Wimmer Matthias D, Ploeger Milena M, Weinhold Leonie, Schmid Matthias, Wirtz Dieter C, Gravius Sascha, Friedrich Max J
Department of Orthopedics and Trauma Surgery, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
Arch Orthop Trauma Surg. 2018 Oct;138(10):1443-1452. doi: 10.1007/s00402-018-3007-9. Epub 2018 Jul 27.
Failed total knee arthroplasty (TKA) with significant bone loss and compromised soft-tissues is challenging and the final results are often inferior to patient's expectation. The objective of this study was to present a comparison of outcomes in patients with failed infected TKA treated with two-stage revision TKA or knee arthrodesis and to assess clinical and functional results, implant survival and infection recurrence. The hypothesis was that an arthrodesis may result in beneficial effects on patients' outcome.
Clinical data of 81 patients with periprosthetic joint infection (PJI) of the knee joint were collected and analyzed retrospectively. Between 2008 and 2014, a total of 36 patients had been treated within a two-stage exchange procedure and reimplantation of a modular intramedullary arthodesis nail and 45 patients with revision TKA. Patients were treated according to the same structured treatment algorithm. Clinical and functional evaluation was performed using the Oxford knee score (OKS) and the visual analogue scale (VAS).
The mean follow-up was 32.9 ± 14.0 months. The rate of definitely free of infection at last follow-up in the arthrodesis group was 32 of 36 (88.9%) and 36 of 45 (80.0%) in the revision TKA group (p = 0.272). Mean VAS for pain in the arthrodesis group was 3.1 ± 1.4 compared to 3.2 ± 1.6 in the revision TKA group (p = 0.636). The OKS in the arthrodesis group was 38.7 ± 8.9 and 36.5 ± 8.9 (p = 0.246) in patients with revision TKA. Rate of revisions in the revision-TKA group was 2.8 ± 3.7 compared to 1.2 ± 2.4 in the arthrodesis group (p = 0.021).
Treatment of PJI needs a distinct therapy with possible fallback strategies in case of failure. A knee arthrodesis is a limb salvage procedure that showed no significant benefits on the considered outcome factors compared to revision TKA but is associated with significantly lower revision rate. After exhausted treatment modalities, a knee arthrodesis should be considered as an option in selected patients.
Level III, retrospective cohort study.
全膝关节置换术（TKA）失败且伴有大量骨质流失和软组织受损的情况具有挑战性，最终结果往往不如患者预期。本研究的目的是比较接受两阶段翻修TKA或膝关节融合术治疗的感染性TKA失败患者的结局，并评估临床和功能结果、植入物存活率及感染复发情况。假设是膝关节融合术可能对患者结局产生有益影响。
回顾性收集并分析81例膝关节假体周围感染（PJI）患者的临床资料。2008年至2014年期间，共有36例患者接受了两阶段置换手术并重新植入模块化髓内融合钉，45例患者接受了TKA翻修手术。患者均按照相同的结构化治疗方案进行治疗。使用牛津膝关节评分（OKS）和视觉模拟量表（VAS）进行临床和功能评估。
平均随访时间为32.9±14.0个月。融合术组最后一次随访时明确无感染的比例为36例中的32例（88.9%），TKA翻修术组为45例中的36例（80.0%）（p = 0.272）。融合术组的平均疼痛VAS为3.1±1.4，而TKA翻修术组为3.2±1.6（p = 0.636）。融合术组的OKS为38.7±8.9，TKA翻修术患者为36.5±8.9（p = 0.246）。TKA翻修术组的翻修率为2.8±3.7，而融合术组为1.2±2.4（p = 0.021）。
PJI的治疗需要独特的治疗方法，并在失败时有可能的备用策略。膝关节融合术是一种保肢手术，与TKA翻修术相比，在所考虑的结局因素上没有显著益处，但翻修率显著更低。在治疗方法用尽后，对于选定的患者应考虑将膝关节融合术作为一种选择。
III级，回顾性队列研究。
