Conti Matthew S, Irwin Todd A, Ford Samuel E, Jones Carroll P, Anderson Robert B, Davis W Hodges
Hospital for Special Surgery, New York, NY, USA.
OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA.
Foot Ankle Int. 2022 Dec;43(12):1614-1621. doi: 10.1177/10711007221133398. Epub 2022 Nov 11.
As total ankle arthroplasty (TAA) becomes more common, chronic periprosthetic joint infections (PJIs) will be encountered more frequently. No studies have reported on patient-reported outcomes following a 2-stage revision procedure for a chronic PJI after a TAA. The primary purpose of this study was to investigate postoperative clinical outcomes at a minimum of 2 years following a 2-stage revision TAA for chronic PJI.
Patients who underwent a 2-stage revision TAA for a chronic PJI (>4 weeks after a primary TAA) between January 2010 and December 2019 were eligible to be included in this study. Chronic PJI was defined as a sinus tract that directly communicated with the prosthesis or the same organism identified in ≥2 synovial fluid samples. Twelve patients were eligible to be included in this case series. One patient died prior to 2-year follow-up, which left 11 patients available for analysis. All 11 patients underwent reimplantation. The data were found not to be normally distributed; therefore, medians and interquartile ranges (IQRs) were reported.
At a median of 3.0 years (IQR 2.0-4.0 years) following the second stage of their revision arthroplasty, the median Foot and Ankle Ability Measure (FAAM) Activities of Daily Living and Sports scores were 60.7 (IQR 52.4, 79.8) and 31.3 (IQR 9.4, 40.6), respectively. At final follow-up, 10 patients (90.9%) were ambulating with a TAA in place. Seven patients (63.6%) required a reoperation including 1 patient who underwent a below-knee amputation.
Our study suggests that a 2-stage revision TAA may be an option for patients with a chronic PJI. However, patients who undergo a 2-stage revision TAA for a chronic PJI have lower than previously published 2-year FAAM scores and a high rate of reoperation.
Level IV, case series.
随着全踝关节置换术（TAA）越来越普遍，慢性假体周围关节感染（PJI）的发生率也会越来越高。目前尚无关于TAA术后慢性PJI两阶段翻修术后患者报告结局的研究。本研究的主要目的是调查慢性PJI两阶段翻修TAA术后至少2年的临床结局。
2010年1月至2019年12月期间因慢性PJI（初次TAA术后>4周）接受两阶段翻修TAA的患者符合纳入本研究的条件。慢性PJI定义为与假体直接相通的窦道或在≥2份滑液样本中鉴定出相同的微生物。12例患者符合纳入本病例系列的条件。1例患者在2年随访前死亡，剩余11例患者可供分析。所有11例患者均接受了再次植入。数据呈非正态分布，因此报告中位数和四分位间距（IQR）。
在翻修关节成形术第二阶段后的中位时间为3.0年（IQR 2.0 - 4.0年）时，足部和踝关节功能评定量表（FAAM）日常生活活动和运动评分的中位数分别为60.7（IQR 52.4，79.8）和31.3（IQR 9.4，40.6）。在末次随访时，10例患者（90.9%）佩戴TAA行走。7例患者（63.6%）需要再次手术，其中1例患者接受了膝下截肢。
我们的研究表明，两阶段翻修TAA可能是慢性PJI患者的一种选择。然而，因慢性PJI接受两阶段翻修TAA的患者，其FAAM评分低于先前发表的2年评分，且再次手术率较高。
IV级，病例系列。
