Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany.
Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Giessen, Germany.
J Knee Surg. 2022 May;35(6):645-652. doi: 10.1055/s-0040-1716416. Epub 2020 Sep 9.
Persistent periprosthetic infection following total knee arthroplasty is one of the most dreaded complications of orthopaedic surgery. Treatment strategies include arthrodesis of the knee joint, stable fistula, long-lasting antibiotic therapy, or above-knee amputation. The advantage of amputation in comparison to other treatment options is the possible cure of infection, because the source of infection is removed and no foreign material left in situ. The aim of the study is to examine whether a septic amputation of the femur in case of persistent periprosthetic infection at the knee joint leads to the healing of the patient. Moreover, the physical and mental state should be evaluated. All patients with above-knee amputation because of periprosthetic joint infection after primary total knee arthroplasty between 2016 and 2018 were included in this retrospective study. A questionnaire with the clinical scores visual analog scale, modified Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Survey has been designed. In addition, all characteristics and perioperative data were documented. Eleven patients were included in the study. One patient died after above-knee amputation; all other patients live with a marked impairment of quality of life but with absence of the infection of the leg. Two out of ten are able to walk regularly with an exoprosthesis with forearm crutches, 50% are in a wheelchair, while 30% are bedridden. Patients with above-knee amputation after persistent periprosthetic infections were free of infection and without signs of inflammation. However, this is associated with worse mobility and high mortality rate.
膝关节置换术后持续性假体周围感染是矫形外科最可怕的并发症之一。治疗策略包括膝关节融合术、稳定瘘管、长期抗生素治疗或膝上截肢。与其他治疗选择相比，截肢的优势在于感染可能得到治愈，因为感染源被去除，体内没有留下任何异物。本研究旨在检查膝关节假体周围感染持续存在的情况下，股骨感染性截肢是否能使患者康复。此外，还应评估其身体和精神状态。本回顾性研究纳入了 2016 年至 2018 年间因初次全膝关节置换术后假体周围关节感染而行膝上截肢的所有患者。设计了一份带有临床评分视觉模拟量表、改良 Lysholm、西安大略和麦克马斯特大学骨关节炎指数和 36 项简短调查问卷的问卷。此外，还记录了所有特征和围手术期数据。本研究共纳入 11 例患者。1 例患者在膝上截肢后死亡；所有其他患者的生活质量明显受损，但腿部无感染。10 例中有 2 例能够使用前臂拐杖定期行走，50%的人坐轮椅，30%的人卧床不起。持续性假体周围感染后行膝上截肢的患者无感染且无炎症迹象。然而，这与较差的活动能力和高死亡率相关。
