Kuo Feng-Chih, Lin Po-Chun, Bell Kerri L, Ko Jih-Yang, Wang Ching-Jen, Wang Jun-Wen
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Knee Surg. 2020 Jun;33(6):597-602. doi: 10.1055/s-0039-1683889. Epub 2019 May 6.
Postoperative prophylactic antibiotics administered within 24 hours of primary total knee arthroplasty (TKA) have been documented to prevent periprosthetic joint infection (PJI). However, the effectiveness of this regimen is still unclear in aseptic revision TKA. The purpose of this study was to evaluate whether extended postoperative prophylactic antibiotics would reduce the PJI rate compared with the current 24-hour standard postoperative prophylactic antibiotics after aseptic revision TKA. A retrospective review of 236 patients (46 men, 190 women, 252 knees) who underwent aseptic revision TKA between 2005 and 2013 was conducted. Patients who underwent septic revision, had a positive intraoperative culture, or who had less than 2 years of follow-up were excluded. Patients were divided according to the duration of postoperative prophylactic antibiotics to standard group (76 knees, ≤ 24 hours) or extended group (176 knees, > 24 hours). PJI was determined by the Musculoskeletal Infection Society criteria. A multivariate Cox proportional hazards regression analysis was performed. The mean follow-up was 5.2 ± 2.5 years. Patients with extended postoperative prophylactic antibiotics had a lower PJI rate (1.1%) compared with standard group (3.9%), but the difference was not statistically significant ( = 0.14). Body mass index ≥ 30 kg/m was the only independent risk factor of PJI (adjusted hazard ratio [HR]: 9.59; 95% confidence interval [CI]: 1.07-86.04, = 0.043). The use of extended postoperative prophylactic antibiotics was not a risk factor for PJI (adjusted HR: 0.34; 95% CI: 0.06-2.04, = 0.238). After 10 years, the two groups had similar infection-free implant survival rate (95.9 vs. 98.9%, = 0.15). Our findings demonstrate that extended postoperative prophylactic antibiotics did not reduce PJI rate compared with the standard group in aseptic revision TKA. A further prospective, randomized study with a standardized postoperative antibiotic protocol is necessary to address this topic. Level of evidence is prognostic Level III.
已有文献证明，在初次全膝关节置换术（TKA）后24小时内使用术后预防性抗生素可预防假体周围关节感染（PJI）。然而，在无菌性翻修TKA中，这种治疗方案的有效性仍不明确。本研究的目的是评估与目前无菌性翻修TKA术后24小时标准预防性抗生素相比，延长术后预防性抗生素使用时间是否会降低PJI发生率。对2005年至2013年间接受无菌性翻修TKA的236例患者（46例男性，190例女性，252个膝关节）进行了回顾性研究。排除接受感染性翻修、术中培养阳性或随访时间少于2年的患者。根据术后预防性抗生素使用时间将患者分为标准组（76个膝关节，≤24小时）或延长组（176个膝关节，>24小时）。PJI根据肌肉骨骼感染学会标准确定。进行了多因素Cox比例风险回归分析。平均随访时间为5.2±2.5年。与标准组（3.9%）相比，术后预防性抗生素使用时间延长的患者PJI发生率较低（1.1%），但差异无统计学意义（P=0.14）。体重指数≥30kg/m²是PJI的唯一独立危险因素（调整后风险比[HR]：9.59；95%置信区间[CI]：1.07-86.04，P=0.043）。术后预防性抗生素使用时间延长不是PJI的危险因素（调整后HR：0.34；95%CI：0.06-2.04，P=0.238）。10年后，两组的无感染植入物生存率相似（95.9%对98.9%，P=0.15）。我们的研究结果表明，在无菌性翻修TKA中，与标准组相比，延长术后预防性抗生素使用时间并未降低PJI发生率。有必要进行一项进一步的前瞻性、随机研究，并采用标准化的术后抗生素方案来解决这一问题。证据水平为预后性III级。
