Bene Nicholas, Li Xing, Nandi Sumon
Tufts University School of Medicine, Boston, MA, United States of America.
Dartmouth Geisel School of Medicine, Hanover, NH, United States of America.
Knee. 2018 Oct;25(5):932-938. doi: 10.1016/j.knee.2018.07.003. Epub 2018 Aug 13.
We sought to determine if reoperation-free survival following irrigation and debridement with polyethylene liner exchange of acutely infected primary TKA is affected by: 1) postoperative antibiotic duration; 2) patient characteristics or surgical factors; 3) infecting organism; or 4) whether infection was acute postoperative versus hematogenous.
Of revision TKAs from 2004 to 2012 (n = 1735), 76 underwent irrigation and debridement (I&D) with liner exchange after primary TKA with mean 3.5-year follow-up. We analyzed those requiring reoperation for infection (n = 21) versus those who did not (n = 55).
Increased duration of postoperative antibiotic therapy (p = 0.0163) decreased reoperation for infection. Atrial fibrillation (p = 0.0053), chronic obstructive pulmonary disease (COPD) (p = 0.0122), more than 15 cells per high powered field (HPF) (p = 0.0124), or higher preoperative C-reactive protein (p = 0.0025) increased reoperation for infection. Incidence of infection recurrence was highest with Methicillin resistant S. aureus (MRSA) and lowest with Gram negative organisms. There was no difference in reoperation-free survival between acute postoperative and hematogenous infections.
Reoperation-free survival following I&D with polyethylene liner exchange of acutely infected primary TKA: 1) improves with increased postoperative antibiotic therapy duration so chronic antibiotic suppression should be considered following TKA I&D with liner exchange; 2) is worse with atrial fibrillation, COPD, >15 cells/HPF, preoperative C-reactive protein >500 mg/L, or MRSA so two-stage revision may be favored in these patients; and 3) is equivalent in acute postoperative and hematogenous infections.
我们试图确定初次全膝关节置换术（TKA）急性感染后行冲洗清创及聚乙烯衬垫置换术后无再次手术生存是否受以下因素影响：1）术后抗生素使用时长；2）患者特征或手术因素；3）感染病原体；4）感染是术后急性感染还是血源性感染。
在2004年至2012年的翻修全膝关节置换术（n = 1735）中，76例在初次全膝关节置换术后行冲洗清创（I&D）及衬垫置换，平均随访3.5年。我们分析了因感染需要再次手术的患者（n = 21）与未再次手术的患者（n = 55）。
术后抗生素治疗时长增加（p = 0.0163）可降低因感染而再次手术的概率。心房颤动（p = 0.0053）、慢性阻塞性肺疾病（COPD）（p = 0.0122）、每高倍视野超过15个细胞（p = 0.0124）或术前C反应蛋白水平较高（p = 0.0025）会增加因感染而再次手术的概率。耐甲氧西林金黄色葡萄球菌（MRSA）感染复发率最高，革兰阴性菌感染复发率最低。术后急性感染和血源性感染的无再次手术生存率无差异。
初次全膝关节置换术急性感染后行冲洗清创及聚乙烯衬垫置换术后的无再次手术生存：1）随术后抗生素治疗时长增加而改善，因此在初次全膝关节置换术后行冲洗清创及衬垫置换后应考虑长期抗生素抑制治疗；2）在有心房颤动、COPD、每高倍视野>15个细胞、术前C反应蛋白>500mg/L或感染病原体为MRSA的患者中情况较差，因此这些患者可能更适合二期翻修；3）术后急性感染和血源性感染的情况相当。
