Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Arthroplasty. 2020 Mar;35(3):855-858. doi: 10.1016/j.arth.2019.10.025. Epub 2019 Oct 19.
Resection arthroplasty of the hip is considered a viable option after multiple failed attempts to eradicate a prosthetic joint infection (PJI). However, much less information about resection arthroplasty of the knee is available. The goals of this study were to determine the success of infection eradication with a resection arthroplasty of the knee and subsequent functional outcomes in this group.
We retrospectively identified 25 knees (23 patients) treated with resection arthroplasty of the knee for PJI performed at a single institution between 1974 and 2016. The mean age at resection arthroplasty was 65 years. The mean body mass index was 37 kg/m, and the mean Charleston Comorbidity Index was 5. Patients had a mean of 5 operations on the knee (mean of 3 operations for infection) before the resection arthroplasty. Failure to eradicate the infection was defined as any reoperation for infection. Clinical outcomes were assessed via ambulatory status, use of gait aids, and ongoing pain. The mean follow-up was 4 years.
At most recent follow-up, 84% (21 of 25) of knees were free of infection. Three patients had recurrent infection within the first year, and 1 patient had a late infection at 4 years postoperatively. However, only 1 patient required a subsequent amputation. Forty-five percent were community ambulators, 35% were household ambulators, and 20% were only able to transfer. All patients required knee bracing and assistive devices. Fifteen percent of patients were using long-term narcotics.
This large series demonstrates the results of selected use of resection arthroplasty as a treatment for recalcitrant periprosthetic knee infections that have failed multiple attempts to eradicate an ongoing PJI. The resection definitively solved the infection in 84% of patients. Functional results were variable but surprisingly good in some. All patients required bracing and assistive devices.
髋关节切除关节成形术被认为是在多次尝试根除人工关节感染（PJI）失败后的可行选择。然而，关于膝关节切除关节成形术的信息要少得多。本研究的目的是确定膝关节切除关节成形术根除感染的成功率以及该组患者的后续功能结果。
我们回顾性地确定了 1974 年至 2016 年期间在一家机构接受膝关节切除关节成形术治疗 PJI 的 25 例膝关节（23 例患者）。切除关节成形术时的平均年龄为 65 岁。平均体重指数为 37kg/m，Charleston 合并症指数平均为 5。患者在切除关节成形术前平均有 5 次膝关节手术（平均 3 次用于感染）。感染未根除的定义为任何因感染而再次手术。临床结果通过步行状态、步态辅助器的使用和持续疼痛来评估。平均随访时间为 4 年。
在最近的随访中，84%（21/25）的膝关节无感染。3 例患者在术后 1 年内出现复发性感染，1 例患者在术后 4 年内出现迟发性感染。然而，只有 1 例患者需要后续截肢。45%的患者为社区步行者，35%的患者为家庭步行者，20%的患者只能转移。所有患者均需要膝关节支具和辅助设备。15%的患者长期使用麻醉性镇痛药。
本大规模系列研究展示了选择性使用切除关节成形术治疗复发性人工膝关节感染的结果，这些感染在多次尝试根除持续存在的 PJI 后仍未成功。切除术明确解决了 84%患者的感染问题。功能结果各不相同，但在某些患者中出人意料地较好。所有患者均需要支具和辅助设备。
