Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria.
Department of Internal Medicine, Medical University of Graz, Graz, Austria.
J Arthroplasty. 2020 Sep;35(9):2601-2606.e1. doi: 10.1016/j.arth.2020.04.078. Epub 2020 Apr 29.
Increasing total hip (THA) and knee (TKA) arthroplasties inevitably lead to accumulating failed arthroplasty (FA) with periprosthetic joint infections (PJI) and definite treatment recommendations are scarce. Our aims were to evaluate patient and infection site specific risk factors, and to identify case-dependent salvage procedure recommendations.
Retrospective analysis was conducted of salvage procedures for FA after PJI (amputation, Girdlestone resection arthroplasty [GRA], arthrodesis, or chronic fistulation [CF]) from 2008 to 2018. Univariable and multivariable modeling of revision and mortality rates, using cumulative incidence competing risk analysis, and Cox proportional hazards models were calculated.
In total, 135 patients (THA 62%; TKA 38%) were diagnosed for FA after PJI, having undergone an average of 3 [1-4] revisions at a mean follow-up of 12.8 [7.8-20.9] years. Forty-four percent of THAs and 55% of TKAs had to be revised following FA, 44% deceased during follow-up, and 16% could be reconverted to an infection-free arthroplasty. GRA revealed significantly higher revision rates than CF (P = .015) for THA. Lower age (P = .003), higher number of revisions before FA (P = .007), more than one microorganism at infection site (P = .034), and GRA (P = .037, only THA) prevailed independent risk factors for revision. Patients' age remained an independent mortality risk factor (P = .001).
High-risk patients suffering from FA after THA with poor constitution profit from controlled constitution of CF, reducing the risk for revision surgeries and hospitalization. In case of FA after TKA, data did not allow definite treatment recommendations. We believe that education concerning amputation should be considered early after multiple TKA revisions.
全髋关节置换术（THA）和全膝关节置换术（TKA）数量的增加不可避免地导致了失败关节置换术（FA）的积累，同时伴有假体周围关节感染（PJI），且目前治疗方法非常有限。我们的目的是评估患者和感染部位的特定危险因素，并确定依赖于具体病例的治疗建议。
回顾性分析了 2008 年至 2018 年因 PJI 后 FA 而接受保肢手术（截肢、Girdlestone 切除术[GRA]、关节融合或慢性窦道形成[CF]）的患者。采用累积发病率竞争风险分析和 Cox 比例风险模型，对翻修率和死亡率进行单变量和多变量建模。
共 135 例患者（THA 占 62%；TKA 占 38%）在 PJI 后被诊断为 FA，在平均 12.8 [7.8-20.9]年的随访中平均接受了 3 [1-4]次翻修。44%的 THA 和 55%的 TKA 在 FA 后需要翻修，44%的患者在随访期间死亡，16%的患者可以再次转为无感染的关节置换。GRA 与 CF 相比，THA 的翻修率显著更高（P=0.015）。年龄较低（P=0.003）、FA 前翻修次数较多（P=0.007）、感染部位存在一种以上微生物（P=0.034）和 GRA（仅 THA，P=0.037）是翻修的独立危险因素。患者年龄仍是独立的死亡风险因素（P=0.001）。
THA 后 FA 且体质较差的高危患者从 CF 得到控制中受益，降低了翻修手术和住院的风险。TKA 后 FA 时，数据不允许明确的治疗建议。我们认为，在多次 TKA 翻修后应考虑早期截肢教育。
