Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy.
Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy.
Arch Orthop Trauma Surg. 2022 Mar;142(3):481-490. doi: 10.1007/s00402-021-04265-5. Epub 2021 Nov 23.
Despite the standardization of two-stage knee revision protocols, a high percentage of failures still occurs. Identifying the predictors of failure is necessary to determine appropriate management and counsel for patients with a periprosthetic knee infection. This study aimed to identify risk factors predicting the failure, to describe implant survival, and to report the mid-term clinical outcomes of patients undergoing two-stage revision for periprosthetic knee infection.
Data of patients who underwent two-stage knee revision from 2012 to 2016 were analyzed, and 108 patients were included. The mean age was 66.6 ± 9.2 years. The mean follow-up was 52.9 ± 15.6 months. Logistic regression was conducted to identify predictors of treatment failure. Kaplan-Meier curves were generated to assess implant survival. Preoperative functional outcomes were compared to those registered at the final follow-up.
Difficult-to-treat infections (OR = 4.2, 95% CI 1.2-14.5, p = 0.025), the number of previous surgeries (OR = 1.8, 95% CI 1.2-2.6, p = 0.005), and the level of tibial bone defect (OR = 2.3, 95% CI 1.1-4.7, p = 0.027) significantly predicted the failure of two-stage knee revision. Survivorship of implants was significantly lower for patients presenting these risk factors (p < 0.05). Mean Knee Society Score improved from 49.0 ± 12.0 to 80.2 ± 13.6 (p < 0.001). Mean Oxford Knee Score improved from 22.2 ± 4.9 to 36.1 ± 6.0 points (p < 0.001).
Difficult-to-treat pathogens, the number of previous surgeries, and the level of tibial bone defect were independent risk factors of two-stage knee revision failure. Overall, the two-stage protocol provided a good survival rate and functional outcome.
尽管两阶段膝关节翻修方案已经标准化，但仍有很高的失败率。确定失败的预测因素对于确定患有假体周围膝关节感染的患者的适当管理和咨询是必要的。本研究旨在确定预测失败的风险因素，描述植入物的存活率，并报告接受两阶段翻修治疗假体周围膝关节感染的患者的中期临床结果。
分析了 2012 年至 2016 年接受两阶段膝关节翻修的患者数据，共纳入 108 例患者。平均年龄为 66.6±9.2 岁。平均随访时间为 52.9±15.6 个月。采用逻辑回归分析确定治疗失败的预测因素。生成 Kaplan-Meier 曲线评估植入物的存活率。比较术前功能结果与最终随访时的结果。
难以治疗的感染（OR=4.2，95%CI 1.2-14.5，p=0.025）、既往手术次数（OR=1.8，95%CI 1.2-2.6，p=0.005）和胫骨骨缺损程度（OR=2.3，95%CI 1.1-4.7，p=0.027）显著预测了两阶段膝关节翻修的失败。具有这些危险因素的患者的植入物存活率明显较低（p<0.05）。膝关节协会评分从 49.0±12.0 提高到 80.2±13.6（p<0.001）。牛津膝关节评分从 22.2±4.9 提高到 36.1±6.0 分（p<0.001）。
难以治疗的病原体、既往手术次数和胫骨骨缺损程度是两阶段膝关节翻修失败的独立危险因素。总体而言，两阶段方案提供了良好的存活率和功能结果。
