West Middlesex University Hospital, London, UK.
a:1:{s:5:"en_US";s:24:"Royal Victoria Infirmary";}.
Acta Biomed. 2021 Jul 1;92(3):e2021197. doi: 10.23750/abm.v92i3.10956.
Background Joint infection following total knee arthroplasty has significant consequences on both the patient and healthcare system. Two stage revision arthroplasties is viewed as the gold standard in management. However, recurrence of infection following this procedure is a growing clinical problem for a multitude of reasons. Despite a variety of surgical options for management of failure of two-stage revision arthroplasty, the potential for complications and functional limitation remains high, and the optimal strategy is yet to be determined. Methods We performed a systematic review of all papers reporting on the outcomes of the surgical management of failure of two-stage revision arthroplasty published up to and including January 2020. Data was extracted on patient demographics, study design, methodological quality, indication for surgery, surgical technique, clinical and functional outcomes, and complications. Results Nine papers with a total of 273 patients were found and analysed All surgical techniques had mixed results in term of clinical and functional outcomes, and the rate of complications was high in all studies. Knee arthrodesis had the lower risk of failure than repeat 2 stage revision. Poor patient immunological status and limb status were weakly associated with increased risk of failure. Conclusion Despite failure of two-stage revision arthroplasty being a growing clinical issue, we were not able to identify any consistently superior surgical technique for the management of this scenario. Knee arthrodesis appears to provide the best results for improving quality of life and reducing infection recurrence, although the complication rate is high and the functional outcomes appear to be worse. Further larger and prospective studies are needed to elucidate optimal surgical management in different patient subsets.
背景
全膝关节置换术后关节感染对患者和医疗系统都有重大影响。两阶段翻修术被视为该疾病的治疗金标准。然而，由于多种原因，这种手术后感染的复发是一个日益严重的临床问题。尽管有多种手术方法可用于治疗两阶段翻修术失败，但仍存在并发症和功能受限的高风险，并且最佳策略尚未确定。
方法
我们对截至 2020 年 1 月所有报告两阶段翻修术失败手术治疗结果的论文进行了系统回顾。提取了患者人口统计学、研究设计、方法学质量、手术适应证、手术技术、临床和功能结果以及并发症的数据。
结果
共发现并分析了 9 篇论文，共计 273 例患者。所有手术技术在临床和功能结果方面均有不同程度的结果，所有研究的并发症发生率均较高。膝关节融合术的失败风险低于重复两阶段翻修术。患者免疫状态和肢体状况差与失败风险增加有关。
结论
尽管两阶段翻修术失败是一个日益严重的临床问题，但我们无法确定任何一种始终优越的手术技术可用于治疗这种情况。膝关节融合术似乎可提供改善生活质量和降低感染复发率的最佳效果，尽管并发症发生率较高，功能结果似乎较差。需要进一步进行更大规模和前瞻性的研究，以阐明不同患者亚组的最佳手术治疗方法。
