Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Biostatistics Core, Hospital for Special Surgery, New York, USA.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3621-3632. doi: 10.1007/s00167-020-06325-6. Epub 2020 Oct 20.
Two-stage exchange arthroplasty is considered the gold standard for treatment of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). Antibiotic cement spacers can include cement-based spacers (CBS), new components (NEW), and autoclaved components (ACL). The factors that most influence post-reimplantation prosthesis (PRP) survival were determined.
A retrospective database review of patients undergoing two-stage exchange arthroplasty from 2008 to 2014 was performed. There were 85 patients, 25 patients and 30 patients in CBS, NEW and ACL groups, respectively. Patient, disease and surgical characteristics were collected and analyzed. Post-reimplantation prosthesis (PRP) survival was modeled using the Kaplan-Meier method. Cox proportional hazard modeling was then performed to identify risk factors associated with implant failure.
Overall PRP survival was 82% in 140 unilateral TKAs. PRP survival between groups was 81%, 96% and 73% within the minimum 2-year follow-up period, respectively. There was a difference in median interval-to-reimplantation between groups (CBS, 72.0 days; NEW, 111.0 days; ACL, 84.0 days, p = 0.003). Adjusting for time-to-reimplantation, NEW spacers demonstrated greater PRP survival compared with ACL spacers (p = 0.044), and a trend towards greater survival compared with CBS spacers (p = 0.086). Excluding early failures (< 90 days), NEW spacers still demonstrated greater survival than ACL spacers (p = 0.046). Lower volume (≤ 10 within this series) surgeons tended to use more CBS spacers, while higher volume surgeons were comfortable with ACL spacers.
There was greater PRP survival with NEW spacers. NEW spacers also demonstrated an increased inter-stage interval, likely because of increased comfort and motion. There were spacer choice differences between low- and high-volume surgeons.
III.
对于全膝关节置换术后发生的假体周围关节感染（PJI），两阶段置换术被认为是金标准。抗生素骨水泥间隔物可包括基于骨水泥的间隔物（CBS）、新型部件（NEW）和高压灭菌部件（ACL）。本研究旨在确定影响再植入后假体（PRP）存活率的最重要因素。
对 2008 年至 2014 年期间接受两阶段置换术的患者进行回顾性数据库研究。CBS、NEW 和 ACL 组分别有 25 例、30 例和 30 例患者。收集并分析患者、疾病和手术特征。采用 Kaplan-Meier 法对再植入后假体（PRP）存活率进行建模。然后进行 Cox 比例风险建模，以确定与植入物失败相关的风险因素。
在 140 例单侧 TKA 中，总体 PRP 存活率为 82%。在至少 2 年的随访期间，各组的 PRP 存活率分别为 81%、96%和 73%。各组的中位再植入间隔时间存在差异（CBS 组为 72.0 天；NEW 组为 111.0 天；ACL 组为 84.0 天，p=0.003）。调整再植入时间后，NEW 间隔物的 PRP 存活率高于 ACL 间隔物（p=0.044），且与 CBS 间隔物相比有更高的存活率趋势（p=0.086）。排除早期失败（<90 天）后，NEW 间隔物的存活率仍高于 ACL 间隔物（p=0.046）。低容量（本研究系列中≤10 例）的医生倾向于使用更多的 CBS 间隔物，而高容量的医生则对 ACL 间隔物更放心。
NEW 间隔物的 PRP 存活率更高。NEW 间隔物还表现出间隔期延长，可能是因为增加了舒适度和活动度。低容量和高容量医生之间存在间隔物选择差异。
III 级。
Zotero 插件