Tuecking Lars-Rene, Silligmann Julia, Savov Peter, Omar Mohamed, Windhagen Henning, Ettinger Max
Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany.
Antibiotics (Basel). 2021 Sep 27;10(10):1177. doi: 10.3390/antibiotics10101177.
Periprosthetic joint infection (PJI) remains one of the most common causes of revision knee arthroplasty. Controversy continues to surround the proper operative technique of PJI in knee arthroplasty with single- or two-stage replacement. Significant variations are seen in the eradication rates of PJI and in implant survival rates. This detailed retrospective analysis of a single tertiary center is intended to provide further data and insight comparing single- and two-stage revision surgery. A retrospective analysis of all revision total knee arthroplasty (TKA) surgeries from 2013 to 2019 was performed and screened with respect to single- or two-stage TKA revisions. Single- and two-stage revisions were analyzed with regard to implant survival, revision rate, microbiological spectrum, and other typical demographic characteristics. A total of 63 patients were included, with 15 patients undergoing single-stage revision and 48 patients undergoing two-stage revision. The mean follow-up time was 40.7 to 43.7 months. Statistically, no difference was found between both groups in overall survival (54.4% vs. 70.1%, = 0.68) and implant survival with respect to reinfection (71.4% vs. 82.4%, = 0.48). Further, high reinfection rates were found for patients with difficult-to-treat organisms and low- to semi-constrained implant types, in comparison to constrained implant types. A statistically comparable revision rate for recurrence of infection could be shown for both groups, although a tendency to higher reinfection rate for single-stage change was evident. The revision rate in this single-center study was comparably high, which could be caused by the high comorbidity and high proportion of difficult-to-treat bacteria in patients at a tertiary center. In this patient population, the expectation of implant survival should be critically discussed with patients.
人工关节周围感染（PJI）仍然是膝关节置换翻修术最常见的原因之一。在膝关节置换术中，单阶段或两阶段置换治疗PJI的正确手术技术仍存在争议。PJI的根除率和植入物存活率存在显著差异。这项对单一三级中心的详细回顾性分析旨在提供更多数据，并比较单阶段和两阶段翻修手术的见解。对2013年至2019年所有膝关节置换翻修术（TKA）进行回顾性分析，并根据单阶段或两阶段TKA翻修进行筛选。分析单阶段和两阶段翻修的植入物存活率、翻修率、微生物谱和其他典型人口统计学特征。共纳入63例患者，其中15例行单阶段翻修，48例行两阶段翻修。平均随访时间为40.7至43.7个月。统计学上，两组在总体存活率（54.4%对70.1%，P = 0.68）和植入物抗再感染存活率（71.4%对82.4%，P = 0.48）方面没有差异。此外，与限制性植入物类型相比，难治性微生物和低至半限制性植入物类型的患者再感染率较高。两组感染复发的翻修率在统计学上具有可比性，尽管单阶段更换的再感染率有升高趋势。在这个单中心研究中，翻修率相对较高，这可能是由于三级中心患者的高合并症和难治性细菌比例高所致。在这个患者群体中，应与患者认真讨论植入物存活的预期情况。
