Department of Joint Replacement Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
Complex Arthroplasty Unit, St George's Hospital, London, United Kingdom.
J Arthroplasty. 2021 Feb;36(2):711-716. doi: 10.1016/j.arth.2020.08.015. Epub 2020 Aug 10.
A wide range of success rates following the surgical management of enterococcal periprosthetic joint infection (PJI) with a tendency toward worse outcomes have been reported. However, the role of 1-stage exchange remains under-investigated. Therefore, we aimed to evaluate our results after the 1-stage knee exchange for enterococcal PJI.
Forty patients were retrospectively included between 2002 and 2017 with a mean follow-up of survivors of 80 months (range 22-172; standard deviation [SD] = 5). Polymicrobial infections occurred in 45% (18/40) of patients. Patients' characteristics, joint-related data, and antibiotic therapy were recorded. Rates of enterococcal infection relapse, reinfection with new microorganisms, and re-revision for any reason were determined. Bivariate analysis was conducted to identify risk factors of infection recurrence.
Revision surgery was required in 22 cases (55%) with a mean time to revision surgery of 27 months (range 1-78; SD = 25). Indications for aseptic revisions (18%) included aseptic loosening (10%), periprosthetic fracture (5%), and patellar instability (3%). The most common cause of re-revision was a subsequent PJI (15/22; 68%) after a mean time of 22 months (range 1-77; SD = 24). Overall infection recurrence rate was 37.5% (15/40), substantially due to entirely non-enterococcal infections (9/15; 60%). Infection relapse with Enterococci occurred in 4 cases (10%) within 16 months postoperatively. Older patients (P = .05) and male gender (P = .05) were associated with a higher risk of infection recurrence.
Overcoming the Enterococci using the 1-stage exchange for knee PJI is achievable but the rate of reinfection due to new microorganisms is high . However, the overall infection recurrence rate is comparable to other treatment approaches.
手术治疗肠球菌性假体周围关节感染（PJI）的成功率差异很大，结果往往较差。然而，一期置换术的作用仍未得到充分研究。因此，我们旨在评估我们对肠球菌性 PJI 进行一期膝关节置换术的结果。
回顾性纳入 2002 年至 2017 年间的 40 例患者，生存患者的平均随访时间为 80 个月（范围 22-172；标准差[SD] = 5）。45%（18/40）的患者发生混合感染。记录患者特征、关节相关数据和抗生素治疗情况。确定肠球菌感染复发、新微生物再感染和任何原因再次翻修的发生率。进行二变量分析以确定感染复发的危险因素。
22 例（55%）需要翻修手术，平均翻修时间为 27 个月（范围 1-78；SD = 25）。无菌性翻修的指征包括无菌性松动（10%）、假体周围骨折（5%）和髌骨不稳定（3%）。再次翻修的最常见原因是 15 例（22%）在 15 个月（范围 1-77；SD = 24）后再次发生 PJI。总体感染复发率为 37.5%（40 例中有 15 例），主要是由于完全非肠球菌感染（9/15；60%）。术后 16 个月内有 4 例（10%）出现肠球菌感染复发。年龄较大的患者（P =.05）和男性（P =.05）感染复发的风险较高。
使用一期置换术治疗膝关节 PJI 可以克服肠球菌，但因新微生物引起的再感染率较高。然而，总体感染复发率与其他治疗方法相当。
