Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts.
J Knee Surg. 2022 Jul;35(9):971-977. doi: 10.1055/s-0040-1721126. Epub 2021 Jan 3.
The primary purpose of this study was to study and compare rates of two salvage operations for patients with chronically infected total knee arthroplasties: (1) knee arthrodesis and (2) above knee amputation (AKA). An analysis was performed comparing the inpatient hospital characteristics and complications between the two procedures. Secondarily, we presented rates of all surgically treated periprosthetic total knee infections over a 6-year period. Using the Nationwide Inpatient Sample, we identified all patients with a periprosthetic infection ( [ICD-9] 996.66) from 2009 to 2014. Subsequently, we identified surgically treated total knee infections through the following ICD-9 codes: 00.80 (all component revision), 00.84 (liner exchange), 80.06 (removal of prosthesis), 84.17 (AKA), and 81.22 (knee fusion). From 2009 to 2014, the annual incidence of surgically treated total knee periprosthetic infections increased by 34.9% nationally, while the annual incidence of primary total knees increased by only 13.9%. Salvage operations (AKA and knee fusion) represented 5.8% of all surgically treated infections. The rate of knee fusions decreased from 1.9% of surgically treated infections in 2009 to 1.4% in 2014 ( < 0.05), while the rate of AKA stayed steady at 4.5% of cases over the 6-year period. Length of stay was significantly shorter in the knee fusion group (7.9 vs. 10.8 days, < 0.05), but total hospital costs were higher (33,016 vs. 24,933, < 0.05). In the multivariable adjusted model, patients undergoing knee fusion had significantly decreased odds of being discharged to skilled nursing facility (odds ratio: 0.42, 95% confidence interval: 0.31-0.58). The annual incidence of surgically treated periprosthetic total knee infections is increasing. The rate of knee arthrodesis for chronic periprosthetic total knee infections is decreasing. Reasons for this downward trend in knee fusions should be evaluated carefully as knee fusions have shown to have the potential advantage of improved mobility and decreased patient morbidity for chronic PJI. The level of evidence is III.
（1）膝关节融合术和（2）膝关节以上截肢术（AKA）。对两种手术的住院患者特征和并发症进行了分析。其次，我们报告了 6 年内所有经手术治疗的全膝关节假体周围感染的发生率。我们使用全国住院患者样本，从 2009 年至 2014 年确定了所有假体周围感染（[ICD-9]996.66）患者。随后，我们通过以下 ICD-9 代码确定了经手术治疗的全膝关节感染：00.80（所有组件翻修），00.84（衬垫更换），80.06（假体取出），84.17（AKA）和 81.22（膝关节融合）。从 2009 年至 2014 年，全国范围内经手术治疗的全膝关节假体周围感染的年发生率增加了 34.9%，而初次全膝关节置换术的年发生率仅增加了 13.9%。挽救手术（AKA 和膝关节融合术）占所有经手术治疗感染的 5.8%。膝关节融合术的发生率从 2009 年的 1.9%下降到 2014 年的 1.4%（<0.05），而 AKA 的发生率在 6 年期间保持稳定，占病例的 4.5%。膝关节融合组的住院时间明显缩短（7.9 天与 10.8 天，<0.05），但总住院费用更高（33016 美元与 24933 美元，<0.05）。在多变量调整模型中，接受膝关节融合术的患者出院到熟练护理机构的可能性明显降低（优势比：0.42，95%置信区间：0.31-0.58）。经手术治疗的全膝关节假体周围感染的年发生率正在增加。慢性全膝关节假体周围感染的膝关节融合术发生率正在下降。对于膝关节融合术下降的原因，应仔细评估，因为膝关节融合术对于慢性 PJI 具有改善活动能力和降低患者发病率的潜在优势。证据水平为 III 级。
