Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
Department of Orthopedics, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
J Arthroplasty. 2020 Jul;35(7):1857-1861. doi: 10.1016/j.arth.2020.02.065. Epub 2020 Mar 6.
The decision to perform a total knee arthroplasty (TKA) on a previously infected knee is made complicated by the higher risk for both a periprosthetic joint infection (PJI) and early failure. There is currently no standard in the treatment strategy for this group of patients. We here report the outcomes of performing a primary TKA on patients with a prior septic knee arthritis. The aim of our study is to analyze the survival rates of patients with a history of septic arthritis undergoing TKA.
From 2010 to 2018, all patients treated in our institution with a minimum follow-up of 1 year, who have previous histories of knee joint infections and underwent a primary TKA were included in the study. All patients underwent the same surgical protocol and were given systemic and local antibiotic treatment.
Of the 68 knees, there were 4 surgical revisions (5.9%). These included 2 septic revisions due to PJI (2.9%), 1 open arthrolysis for arthrofibrosis (1.5%), and 1 aseptic revision for implant loosening (1.5%). Sixty-four (64) knees (94%) had survived without any surgical interventions and the Kaplan-Meier analysis demonstrated an overall survivorship free from PJI of 97.1% at a mean of 5 years (range 1-9, standard deviation ±2.5 years).
TKA is a suitable option for patients with a prior septic arthritis of the knee, provided that proper surgical technique and the utilization of systemic and local antibiotics are employed.
Level III, therapeutic study.
对于曾经感染过的膝关节，进行全膝关节置换术（TKA）的决策变得复杂，因为发生假体周围关节感染（PJI）和早期失败的风险更高。目前，针对这组患者，尚无标准的治疗策略。我们在此报告对先前患有感染性膝关节炎的患者进行初次 TKA 的结果。我们研究的目的是分析既往患有感染性关节炎接受 TKA 治疗的患者的生存率。
2010 年至 2018 年，我们机构治疗的所有患者均进行了最少 1 年的随访，这些患者有膝关节感染病史，并接受了初次 TKA。所有患者均采用相同的手术方案，并接受了全身和局部抗生素治疗。
在 68 个膝关节中，有 4 例手术翻修（5.9%）。其中包括 2 例因 PJI 而进行的感染性翻修（2.9%）、1 例因关节粘连而行的开放性关节松解术（1.5%）和 1 例因假体松动而行的无菌性翻修术（1.5%）。64 个（64 个膝关节）（94%）膝关节未进行任何手术干预而存活，Kaplan-Meier 分析表明，平均 5 年（范围 1-9 年，标准差±2.5 年）时，总体无 PJI 生存率为 97.1%。
对于有膝关节先前感染性关节炎的患者，只要采用适当的手术技术并使用全身和局部抗生素，TKA 是一种合适的选择。
III 级，治疗性研究。
