Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina.
Duke University School of Medicine, Durham, North Carolina.
J Arthroplasty. 2023 Aug;38(8):1584-1590. doi: 10.1016/j.arth.2023.01.036. Epub 2023 Jan 30.
Although 2-stage revision has been proposed as gold standard for periprosthetic joint infection treatment, limited evidence exists for the role of articulating spacers as definitive management. The purpose of this study was to compare clinical outcomes and costs associated with articulating spacers (1.5-stage) and a matched 2-stage cohort.
A retrospective review was performed for patients who had chronic periprosthetic joint infections after total knee arthroplasty defined by Musculoskeletal Infection Society criteria and were matched via propensity score matching using cumulative Musculoskeletal Infection Society scores and a comorbidity index. Patients who maintained an articulating spacer (cemented cobalt-chrome femoral component and all-poly tibia) were included in the 1.5-stage cohort. Patients who underwent a 2-stage reimplantation procedure were included in the 2-stage cohort. Outcomes included visual analog scale pain scores, 90-day emergency department visits, 90-day readmission, unplanned reoperation, reinfection, as well as cost at 1 and 2-year intervals. A total of 116 patients were included for analyses.
The 90-day pain scores were lower in the 1.5-stage cohort compared to the 2-stage cohort (2.9 versus 4.6, P = .0001). There were no significant differences between readmission and reoperation rates. Infection clearance was equivalent at 79.3% for both groups. Two-stage exchange demonstrated an increased cost difference of $26,346 compared to 1.5-stage through 2 years (P = .0001). Regression analyses found 2 culture-positive results with the same organism decreased the risk for reinfection [odds ratio: 0.2, 95% confidence interval 0.04-0.8, P = .03].
For high-risk candidates, articulating spacers can preserve knee function, reduce morbidity from second-stage surgery, and lower the costs with similar rates of infection clearance as 2-stage exchange.
Level III, therapeutic study.
虽然两期翻修已被提议作为治疗人工关节周围感染的金标准，但关节成形间隔物作为确定性治疗的作用的证据有限。本研究的目的是比较关节成形间隔物（1.5 期）和匹配的两期队列相关的临床结果和成本。
对符合肌肉骨骼感染学会（Musculoskeletal Infection Society，MIS）标准的全膝关节置换术后慢性人工关节周围感染患者进行回顾性研究，并通过累积肌肉骨骼感染学会评分和合并症指数进行倾向评分匹配进行匹配。保留关节成形间隔物（粘结钴铬股骨组件和全聚醚胫骨）的患者纳入 1.5 期队列。接受两期再植入手术的患者纳入两期队列。结果包括视觉模拟评分（visual analog scale pain scores，VAS）疼痛评分、90 天急诊就诊、90 天再入院、非计划性再手术、再感染以及 1 年和 2 年时的成本。共纳入 116 例患者进行分析。
与两期队列相比，1.5 期队列的 90 天疼痛评分较低（2.9 比 4.6，P ＝.0001）。再入院和再手术率之间没有显著差异。两组的感染清除率相当，均为 79.3%。两期置换的成本差异增加了 26346 美元，与 1.5 期相比，2 年时差异有统计学意义（P ＝.0001）。回归分析发现，2 次培养阳性结果且为同一病原体可降低再感染的风险[比值比：0.2，95%置信区间 0.04-0.8，P ＝.03]。
对于高危患者，关节成形间隔物可以保留膝关节功能，减少二期手术的发病率，并降低成本，而感染清除率与两期置换相似。
III 级，治疗性研究。
