Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria.
Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
Knee Surg Sports Traumatol Arthrosc. 2021 Oct;29(10):3186-3194. doi: 10.1007/s00167-020-06106-1. Epub 2020 Jun 17.
The treatment of an infected arthritic knee might be challenging. The failure rate has been reported to be high for open or arthroscopic debridement. A subsequently high rate of infection has been noted in these patients undergoing primary total knee arthroplasty (TKA). In the present study, a two-stage approach using an articulating spacer was used. The hypothesis was that the procedure would eradicate the infection and improve pain and function in these patients.
A total of 16 consecutive patients were enrolled in this retrospective study. The mean follow-up time was 6.1 years (range 2.0-9.9 years). Patients with advanced osteoarthritis and infection of the knee were included. All patients had previously undergone one or more failed arthroscopic or open procedures for the eradication of infection. All patients received the same homemade metal-on-plastic articulating antibiotic spacer. Double antibiotic therapy was given for 2 weeks intravenously and orally for 4 weeks. TKA implantation was performed 6 weeks after the first stage.
The infection was eradicated without recurrence in all patients. The functional results were significantly improved, and pain was significantly reduced after spacer and TKA implantation. The mean amount of knee flexion was 95 ± 30° preoperatively, and it increased to 109 ± 14° (p = 0.012) after spacer implantation and to 119 ± 10° (p = 0.002) after TKA implantation. The mean KSS objective was 58 ± 12 preoperatively, and it increased to 75 ± 14 (p < 0.0001) after spacer implantation and to 96 ± 3 (p < 0.0001) after TKA implantation. The mean KSS function was 17 ± 11 preoperatively, and it increased to 46 ± 10 (p < 0.0001) after spacer implantation and to 86 ± 6 (p < 0.0001) after TKA implantation. The mean VAS score was 65 ± 11 preoperatively, and it decreased to 2 ± 4 (p < 0.0001) after spacer implantation and to 1 ± 2 (p < 0.0001) after TKA implantation.
The two-stage procedure for the treatment of infected arthritic knees after failed eradication surgery was effective in all patients. Using an antibiotic articulating metal-on-plastic cement spacer showed improved functional results between the stages and at the final follow-up. No intra- or postoperative complications occurred.
感染性关节炎膝关节的治疗可能具有挑战性。据报道，开放式或关节镜下清创术的失败率很高。因此，这些患者在接受初次全膝关节置换术（TKA）时，感染率很高。在本研究中，使用了一种关节式间隔物的两阶段方法。假设该手术将消除感染，并改善这些患者的疼痛和功能。
本回顾性研究共纳入 16 例连续患者。平均随访时间为 6.1 年（范围 2.0-9.9 年）。纳入患有晚期骨关节炎和膝关节感染的患者。所有患者之前都曾因感染而接受过一次或多次失败的关节镜或开放式手术。所有患者均接受同种自制金属对塑料关节抗生素间隔物。静脉内给予双联抗生素治疗 2 周，口服 4 周。第 1 阶段后 6 周行 TKA 植入术。
所有患者均无感染复发。间隔物和 TKA 植入后，功能结果明显改善，疼痛明显减轻。膝关节屈曲的平均量术前为 95°±30°，间隔物植入后增加至 109°±14°（p=0.012），TKA 植入后增加至 119°±10°（p=0.002）。术前 KSS 客观评分平均为 58°±12°，间隔物植入后增加至 75°±14°（p<0.0001），TKA 植入后增加至 96°±3（p<0.0001）。术前 KSS 功能评分平均为 17°±11°，间隔物植入后增加至 46°±10°（p<0.0001），TKA 植入后增加至 86°±6（p<0.0001）。术前 VAS 评分平均为 65°±11°，间隔物植入后降低至 2°±4（p<0.0001），TKA 植入后降低至 1°±2（p<0.0001）。
对于失败清除术后感染性关节炎膝关节，两阶段手术治疗在所有患者中均有效。使用抗生素关节式金属对塑料水泥间隔物在各阶段和最终随访时均显示出更好的功能结果。无术中或术后并发症发生。
