Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
Orthop Traumatol Surg Res. 2019 Jun;105(4):647-651. doi: 10.1016/j.otsr.2019.02.022. Epub 2019 Apr 30.
Prosthetic joint infection (PJI) is a rare (incidence, 0.15% to 0.9%) but serious complication of knee arthroplasty. Haematogenous PJI of the knee (KhPJI) which accounts for 10% of cases, has been less studied than PJI due to other mechanisms. The primary objective of this study in patients with KhPJI of the knee was to determine the 2-year infection eradication failure rate after either exchange arthroplasty or arthrotomy/synovectomy/irrigation (ASI), combined with prolonged peri-operative antibiotic therapy, at a referral centre for complex osteo-articular infections.
ASI within 2 weeks after symptom onset and one-stage exchange arthroplasty produce similar 2-year success rates in patients with KhPJI of the knee.
A prospective observational cohort study was performed in patients managed for PJI of the knee between 2003 and 2015. The primary outcome measure was the occurrence of a septic event or of KhPJI -related death during a minimum follow-up of 2 years.
Of 265 patients with PJI after total knee arthroplasty, 58 (22.1%) had KhPJI with onset more than 3 months after the last arthroplasty procedure and were included in the study. Among them, one-third had immune deficiencies. The most common causative organisms were streptococci (n=25, 43%) and Staphylococcusaureus (n=20, 34%). The primary focus of infection was identified in only 64% of patients and was most often cutaneous (n=19, 33%) or dental (n=11, 19%). A septic event or KhPJI-related death occurred in 5/34 (15%) patients after one-stage exchange arthroplasty and 6/19 (32%) patients after ASI within 15 days after symptom onset (p=0.03). Patient characteristics, type of prosthesis, and causative organism were not significantly associated with failure to eradicate the infection.
ASI carried a high failure rate despite being performed within 15 days after symptom onset. One-stage exchange arthroplasty seems to be the best surgical option, particularly as the exact time of symptom onset may be difficult to determine. Identifying and eradicating the primary focus of infection is crucial.
II, low-powered prospective cohort study.
人工关节感染（PJI）是膝关节置换术后一种罕见的（发病率为 0.15%至 0.9%）但严重的并发症。占病例 10%的血源性膝关节感染（KhPJI）由于其他机制的影响，其研究不如其他机制那么多。本研究的主要目的是在膝关节 KhPJI 患者中，确定在发病后 2 周内进行关节置换术或关节切开术/滑膜切除术/灌洗（ASI）联合延长围手术期抗生素治疗后，在复杂的骨关节炎感染转诊中心的 2 年感染清除失败率。
KhPJI 发病后 2 周内进行 ASI 和一期关节置换术，在膝关节 KhPJI 患者中的 2 年成功率相似。
对 2003 年至 2015 年期间因膝关节 PJI 接受治疗的患者进行前瞻性观察队列研究。主要结局指标是在至少 2 年的随访期间发生脓毒症事件或 KhPJI 相关死亡。
在 265 例全膝关节置换术后 PJI 患者中，有 58 例（22.1%）为 KhPJI，发病时间为最后一次关节置换术后 3 个月以上，纳入研究。其中三分之一有免疫缺陷。最常见的病原体是链球菌（n=25，43%）和金黄色葡萄球菌（n=20，34%）。仅 64%的患者确定了感染的原发灶，原发灶最常见的部位是皮肤（n=19，33%）或牙齿（n=11，19%）。在一期关节置换术后，有 5/34（15%）的患者发生了脓毒症事件或 KhPJI 相关死亡，在 KhPJI 发病后 15 天内进行 ASI 的 19 例患者中有 6 例（32%）发生了 KhPJI 相关死亡（p=0.03）。患者特征、假体类型和病原体与感染清除失败无显著相关性。
尽管 KhPJI 在发病后 15 天内进行了 ASI，但失败率仍然很高。一期关节置换术似乎是最佳的手术选择，特别是因为很难确定症状的确切发病时间。确定并清除感染的原发灶是至关重要的。
II 级，低效能前瞻性队列研究。
