Klemt Christian, Tirumala Venkatsaiakhil, Oganesyan Ruben, Xiong Liang, van den Kieboom Janna, Kwon Young-Min
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School.
J Arthroplasty. 2021 Jan;36(1):298-304. doi: 10.1016/j.arth.2020.07.012. Epub 2020 Jul 22.
Single-stage revision is an alternative to the standard 2-stage revision, potentially minimizing morbidities and improving functional outcomes. This study aimed at comparing single-stage and 2-stage revision total knee arthroplasty (TKA) for chronic periprosthetic joint infection (PJI) with regard to patient-reported outcome measures (PROMs) and complication rates.
A total of 185 consecutive revision TKA patients for chronic PJI with complete preoperative and postoperative PROMs were investigated. A total of 44 patients with single-stage revision TKA were matched to 88 patients following 2-stage revision TKA using propensity score matching, yielding a total of 132 propensity score-matched patients for analysis. Patient demographics and clinical information including reinfection and readmission rates were evaluated.
There was no significant difference in preoperative PROMs between propensity score-matched single-stage and 2-stage revision TKA cohorts. Postoperatively, significantly higher PROMs for single-stage revision TKA were observed for Knee disability and Osteoarthritis Outcome Score physical function (62.2 vs 51.9, P < .01), physical function short form 10A (42.8 vs 38.1, P < .01), PROMIS SF Physical (44.8 vs 41.0, P = .01), and PROMIS SF Mental (50.5 vs 47.1, P = .02). There was no difference between propensity score-matched single-stage and 2-stage revision TKA cohorts for clinical outcomes including reinfection rates (25.0% vs 27.2%, P = .78) and 90-day readmission rates (22.7% vs 25.0%, P = .77).
This study illustrated that single-stage revision TKA for chronic PJI may be associated with superior patient-reported outcomes compared to 2-stage revision for the infected TKA using a variety of PROMs. Improved PROMs were not accompanied by differences in complication rates between both cohorts, suggesting that single-stage revision TKA may provide an effective alternative to 2-stage revision in patients with chronic TKA PJI.
一期翻修是标准二期翻修的一种替代方案，有可能将发病率降至最低并改善功能结局。本研究旨在比较一期和二期翻修全膝关节置换术（TKA）治疗慢性假体周围关节感染（PJI）的患者报告结局指标（PROMs）和并发症发生率。
共调查了185例连续接受慢性PJI翻修TKA且术前和术后PROMs完整的患者。使用倾向评分匹配法将44例行一期翻修TKA的患者与88例行二期翻修TKA的患者进行匹配，共132例倾向评分匹配患者纳入分析。评估患者人口统计学和临床信息，包括再感染率和再入院率。
倾向评分匹配的一期和二期翻修TKA队列术前PROMs无显著差异。术后，一期翻修TKA在膝关节残疾和骨关节炎结局评分身体功能（62.2对51.9，P <.01）、简明健康调查10项身体功能量表（42.8对38.1，P <.01）、患者报告结局测量信息系统身体功能量表（44.8对41.0，P =.01）和患者报告结局测量信息系统精神健康量表（50.5对47.1，P =.02）方面的PROMs显著更高。倾向评分匹配的一期和二期翻修TKA队列在包括再感染率（25.0%对27.2%，P =.78）和90天再入院率（22.7%对25.0%，P =.77）在内的临床结局方面没有差异。
本研究表明，与使用多种PROMs的感染性TKA二期翻修相比，慢性PJI的一期翻修TKA可能与更好的患者报告结局相关。PROMs的改善并未伴随着两组并发症发生率的差异，这表明一期翻修TKA可能为慢性TKA PJI患者提供一种有效的二期翻修替代方案。
