Russo Antonio, Cavagnaro Luca, Alessio-Mazzola Mattia, Felli Lamberto, Burastero Giorgio, Formica Matteo
Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy.
Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genova, Italy.
J Clin Orthop Trauma. 2021 Nov 30;24:101720. doi: 10.1016/j.jcot.2021.101720. eCollection 2022 Jan.
Septic arthritis of the native hip and knee joint poses particular challenges to orthopedic surgeons. Patients often suffer from several comorbidities, and it could be challenging to find a balance between infection control and adequate function. Two-stage arthroplasty has been addressed as a reliable solution, however the literature on the topic is composed of case series with small sample size. This systematic review aimed to analyze data on infection control and clinical functional outcomes of patients who underwent two-stage arthroplasty for septic arthritis of the hip and knee.
An electronic search of studies published from January 1st, 2000, to June 1st, 2021, was conducted using eight different databases. Following the Cochrane Handbook of Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Revies and Meta-analysis two authors reviewed the available literature and reference lists to identify papers eligible for inclusion.
A total of 21 studies were included, involving 435 procedures. The mean age was 57.3 ± 6.2 (45.8-71.8) years. The mean follow-up was 53.7 ± 18.6 (12-86.7) months. The mean infection eradication was 93.3 ± 6.4%. Mean Harris Hip Score improved from 32.1 ± 10.6 (11.5-42.9) to 87.5 ± 5.7 (80.6-97.8). Mean Knee Society Score improved from 42.9 ± 7.6 (35.9-58.0) to 86.1 ± 5.4 (80.1-96.0).
Two-stage arthroplasty for hip and knee septic arthritis provided high infection control rate and excellent function. Further high-quality studies should be oriented on providing a validated algorithm for diagnosis and treatment of this condition.
Level IV, systematic review of Level III and IV studies.
原发性髋膝关节化脓性关节炎给骨科医生带来了特殊挑战。患者常伴有多种合并症，在控制感染与维持足够功能之间找到平衡可能具有挑战性。两阶段关节置换术被认为是一种可靠的解决方案，然而关于该主题的文献多为小样本量的病例系列。本系统评价旨在分析接受髋膝关节化脓性关节炎两阶段关节置换术患者的感染控制及临床功能结局数据。
使用八个不同数据库对2000年1月1日至2021年6月1日发表的研究进行电子检索。按照《Cochrane干预措施系统评价手册》及系统评价和Meta分析的首选报告项目，两位作者查阅了现有文献及参考文献列表，以确定符合纳入标准的论文。
共纳入21项研究，涉及435例手术。平均年龄为57.3±6.2（45.8 - 71.8）岁。平均随访时间为53.7±18.6（12 - 86.7）个月。平均感染根除率为93.3±6.4%。平均Harris髋关节评分从32.1±10.6（11.5 - 42.9）提高到87.5±5.7（80.6 - 97.8）。平均膝关节协会评分从42.9±7.6（35.9 - 58.0）提高到86.1±5.4（80.1 - 96.0）。
髋膝关节化脓性关节炎的两阶段关节置换术具有较高的感染控制率和良好的功能。未来高质量研究应致力于提供针对该病症的有效诊断和治疗方案。
IV级，III级和IV级研究的系统评价
