Cavagnaro Luca, Chiarlone Francesco, Mosconi Lorenzo, Zanirato Andrea, Formica Matteo, Burastero Giorgio
Joint Replacement Unit/Bone Infection Unit, Ospedale Santa Corona, Via XXV Aprile 38, 17027, Pietra Ligure, SV, Italy.
Orthopaedic Department, Policlinico San Martino Largo, Rosanna Benzi 10, 16132, Genoa, GE, Italy.
Arch Orthop Trauma Surg. 2022 Aug;142(8):2031-2038. doi: 10.1007/s00402-022-04464-8. Epub 2022 May 19.
Unicompartmental knee arthroplasty (UKA) has an infection rate of 0.1-0.8%. Despite the wide amount of literature about septic total knee arthroplasty management, few data are available for UKA infection treatment. The aim is to present the clinical and radiological outcomes along with complication rates of a series of septic UKA treated with two-stage exchange.
We retrospectively reviewed 16 patient treated with staged UKA revision for infection between June 2015 and September 2019 in a single bone infection unit. The main demographic and surgical data were recorded. Clinical scores (VAS, KSS, OKS, postoperative ROM), radiological parameters (osseointegration, loosening and radiolucencies) and complications were reported. The mean follow-up was 33.5 ± 6.9 months.
Mean age at surgery was 68.5 ± 9.1. All but two were medial UKA. The mean number of previous surgeries was 2.9 ± 1.9. The mean ROM, VAS, KSS and OKS of the entire population improved significantly (p < 0.01). Radiological analysis did not show any migration or implant loosening. Ten constrained condylar and six posterior stabilized prosthesis were finally implanted. One intraoperative pathogen isolation was recorded and managed with suppressive therapy and good final outcome. The implant survivorship free from infection was 100% at the final follow-up. The overall survival rate for any reason of revision was 100% CONCLUSION: According to our results, staged revision represents a reliable ad effective option in delayed and late UKA infections. This technique provides optimal clinical and radiological results with acceptable complication rates. To the best of our knowledge, this represent the widest case series on infected UKA managed with two-stage exchange.
单髁膝关节置换术（UKA）的感染率为0.1%-0.8%。尽管有大量关于感染性全膝关节置换术治疗的文献，但关于UKA感染治疗的数据却很少。目的是介绍一系列采用两阶段翻修治疗的感染性UKA的临床和放射学结果以及并发症发生率。
我们回顾性分析了2015年6月至2019年9月在单一骨感染科接受分期UKA翻修治疗感染的16例患者。记录了主要的人口统计学和手术数据。报告了临床评分（视觉模拟评分法[VAS]、膝关节协会评分[KSS]、牛津膝关节评分[OKS]、术后活动度[ROM]）、放射学参数（骨整合、松动和透亮区）及并发症。平均随访时间为33.5±6.9个月。
手术时的平均年龄为68.5±9.1岁。除2例为外侧UKA外，其余均为内侧UKA。既往手术的平均次数为2.9±1.9次。整组人群的平均ROM、VAS、KSS和OKS均有显著改善（p<0.01）。放射学分析未显示任何移位或植入物松动。最终植入了10个限制性髁假体和6个后稳定型假体。记录到1例术中病原体分离，采用抑制性治疗，最终效果良好。末次随访时无感染的植入物生存率为100%。因任何原因进行翻修的总体生存率为100%。结论：根据我们的结果，分期翻修是延迟和晚期UKA感染的可靠且有效的选择。该技术能提供最佳的临床和放射学结果，并发症发生率可接受。据我们所知，这是关于采用两阶段翻修治疗感染性UKA的最大病例系列。
