Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
Department of Orthopaedics, Division of Lower Limb Reconstruction, University of British Columbia, Vancouver, Canada.
Bone Joint J. 2022 Mar;104-B(3):386-393. doi: 10.1302/0301-620X.104B3.BJJ-2021-0481.R2.
The outcome of repeat septic revision after a failed one-stage exchange for periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat septic revision after a failed one-stage exchange, and to determine whether the Musculoskeletal Infection Society (MSIS) stage is associated with subsequent infection-related failure.
We retrospectively reviewed all repeat septic revision TKAs which were undertaken after a failed one-stage exchange between 2004 and 2017. A total of 33 repeat septic revisions (29 one-stage and four two-stage) met the inclusion criteria. The mean follow-up from repeat septic revision was 68.2 months (8.0 months to 16.1 years). The proportion of patients who had a subsequent infection-related failure and all-cause revision was reported and Kaplan-Meier survival for these endpoints was determined. Patients were categorized according to the MSIS staging system, and the association with subsequent infection was analyzed.
At the most recent follow-up, 17 repeat septic revisions (52%) had a subsequent infection-related failure and the five-year infection-free survival was 59% (95% confidence interval (CI) 39 to 74). A total of 19 underwent a subsequent all-cause revision (58%) and the five-year all-cause revision-free survival was 47% (95% CI 28 to 64). The most common indication for the first subsequent aseptic revision was loosening. The MSIS stage of the host status (p = 0.663) and limb status (p = 1.000) were not significantly associated with subsequent infection-related failure.
Repeat septic revision after a failed one-stage exchange TKA for PJI is associated with a high rate of subsequent infection-related failure and all-cause revision. Patients should be counselled appropriately to manage expectations. The host and limb status according to the MSIS staging system were not associated with subsequent infection-related failure. Cite this article: 2022;104-B(3):386-393.
初次单阶段翻修治疗全膝关节置换术后假体周围关节感染（PJI）失败后再次进行清创翻修的结局仍不清楚。本研究旨在报告初次单阶段翻修治疗 PJI 失败后再次清创翻修的无感染和全因翻修无失败生存率，并确定肌肉骨骼感染协会（MSIS）分期是否与随后的感染相关失败有关。
我们回顾性分析了 2004 年至 2017 年期间初次单阶段翻修治疗 PJI 失败后再次进行的所有清创翻修 TKA。共有 33 例符合纳入标准的再次清创翻修（29 例初次单阶段，4 例 2 阶段）。从再次清创翻修开始的平均随访时间为 68.2 个月（8.0 个月至 16.1 年）。报告了再次清创翻修后发生的感染相关失败和全因翻修的患者比例，并确定了这些终点的 Kaplan-Meier 生存率。根据 MSIS 分期系统对患者进行分类，并分析其与随后感染的关系。
在最近一次随访时，17 例再次清创翻修（52%）发生了感染相关失败，5 年无感染生存率为 59%（95%CI 39%至 74%）。19 例患者进行了全因再次翻修（58%），5 年全因翻修无失败生存率为 47%（95%CI 28%至 64%）。首次后续无菌性翻修的最常见指征是松动。宿主状态（p=0.663）和肢体状态（p=1.000）的 MSIS 分期与随后的感染相关失败无显著相关性。
初次单阶段翻修治疗 PJI 失败后再次进行清创翻修与较高的感染相关失败和全因翻修率相关。应适当告知患者，以管理其预期。根据 MSIS 分期系统的宿主和肢体状态与随后的感染相关失败无关。
