Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Department of Clinical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Bone Joint J. 2021 Aug;103-B(8):1373-1379. doi: 10.1302/0301-620X.103B8.BJJ-2021-0224.R1.
Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI.
A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups.
A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517).
Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: 2021;103-B(8):1373-1379.
单阶段翻修全膝关节置换术（rTKA）在治疗慢性假体周围关节感染（PJI）方面越来越受欢迎。我们已经将这种方法引入我们的临床实践中，并试图评估单阶段和两阶段 rTKA 治疗慢性 PJI 的再感染和再翻修的发生率，以及单阶段和两阶段 rTKA 治疗失败的预测因素。
使用前瞻性数据库对 2003 年 4 月 1 日至 2018 年 12 月 31 日期间所有慢性 PJI 的 rTKA 进行回顾性比较队列研究。排除急性感染患者；rTKA 分为单阶段、阶段 1 或阶段 2 两阶段翻修。主要结局测量指标是未能根除或复发性感染。通过回归分析评估失败的变量包括年龄、BMI、美国麻醉医师协会（ASA）分级、感染病原体和窦道的存在。还比较了两组患者的生存情况。
共纳入 292 例慢性 PJI 初次 rTKA：82 例单阶段（28.1%）；210 例两阶段（71.9%）翻修。平均年龄为 71 岁（27 至 90 岁），女性 165 例（57.4%），平均 BMI 为 30.9kg/m（20 至 53）。单阶段组中已知感染病原体的患者明显更多（93.9% vs 80.47%；p=0.004）。246 例（84.2%）患者术前确定了感染病原体。平均随访 6.3 年（2.0 至 17.6），单阶段组的失败率为 6.1%，两阶段组为 12%。所有失败均发生在治疗后 4 年内。窦道的存在是失败的独立危险因素（比值比（OR）4.97；95%置信区间（CI）1.593 至 15.505；p=0.006），年龄>80 岁也是失败的独立危险因素（OR 5.962；95%CI 1.156 至 30.73；p=0.033）。单阶段组 10 年患者生存率为 72%，两阶段组为 70.5%。差异无统计学意义（p=0.517）。
单阶段 rTKA 是一种有效的策略，在适当选择的患者中成功率高，与两阶段方法相当。
