Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY.
Department of Medicine, Infectious Disease, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2020 Jul;35(7):1917-1923. doi: 10.1016/j.arth.2020.02.036. Epub 2020 Feb 21.
Periprosthetic joint infection (PJI) after unicompartmental knee arthroplasty (UKA) is a devastating but poorly understood complication, with a paucity of published data regarding treatment and outcomes. This study analyzes the largest cohort of UKA PJIs to date comparing treatment outcome, septic and aseptic reoperation rates, and risk factors for treatment failure.
Twenty-one UKAs in 21 patients treated for PJI, as defined by Musculoskeletal Infection Society criteria, were retrospectively reviewed. Minimum and mean follow-up was 1 and 3.5 years, respectively. Fourteen (67%) patients had acute postoperative PJIs. Surgical treatment included 16 debridement, antibiotics, and implant retentions (DAIRs) (76%), 4 two-stage revisions (19%), and 1 one-stage revision (5%). Twenty (95%) PJIs were culture positive with Staphylococcus species identified in 15 cases (71%).
Survivorship free from reoperation for infection at 1 year was 76% (95% confidence interval, 58%-93%). Overall survival from all-cause reoperation was 57% (95% confidence interval, 27%-87%) at 5 years. Two additional patients (10%) underwent aseptic revision total knee arthroplasty for lateral compartment degeneration 1 year after DAIR and tibial aseptic loosening 2.5 years after 2-stage revision. All patients who initially failed PJI UKA treatment presented with acute postoperative PJIs (5 of 14; 36%).
Survivorship free from persistent PJI at 1 year is low at 76% but is consistent with similar reports of DAIRs for total knee arthroplasties. Furthermore, there is low survivorship free from all-cause reoperation of 71% and 57% at 2 and 5 years, respectively. Surgeons should be aware of these poorer outcomes and consider treating UKA PJI early and aggressively.
单髁膝关节置换术后假体周围关节感染（PJI）是一种破坏性但尚未被充分了解的并发症，目前关于其治疗和结果的研究数据很少。本研究分析了迄今为止最大的 UKA PJI 队列，比较了治疗效果、感染性和无菌性再次手术率以及治疗失败的风险因素。
回顾性分析了 21 例符合 Musculoskeletal Infection Society 标准的 PJI 患者的 21 例 UKA。最小和平均随访时间分别为 1 年和 3.5 年。14 例（67%）患者为急性术后 PJI。手术治疗包括 16 例清创术、抗生素和保留假体（DAIR）（76%）、4 例二期翻修（19%）和 1 例一期翻修（5%）。20 例（95%）PJI 培养阳性，15 例（71%）为葡萄球菌属。
1 年无感染再手术的生存率为 76%（95%置信区间，58%-93%）。5 年时，所有原因再手术的总体生存率为 57%（95%置信区间，27%-87%）。2 例患者（10%）在 DAIR 后 1 年因外侧间室退变和 2 期翻修后 2.5 年胫骨无菌性松动行无菌性全膝关节翻修。所有最初 PJI UKA 治疗失败的患者均为急性术后 PJI（14 例中的 5 例；36%）。
1 年时持续 PJI 无生存率为 76%，但与全膝关节置换术 DAIR 的类似报告一致。此外，2 年和 5 年时无全因再手术生存率分别为 71%和 57%。外科医生应该意识到这些较差的结果，并考虑早期积极治疗 UKA PJI。
