Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy.
Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco - ASL Città di Torino, Piazza del Donatore di Sangue, 3, 10154, Turin, Italy.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2703-2715. doi: 10.1007/s00590-023-03480-7. Epub 2023 Mar 3.
Periprosthetic joint infection (PJI) of the knee represents a severe complication after 1.5% to 2% of primary total knee replacement. Although two-stage revision was considered the gold-standard treatment for PJI of the knee, in the last decades, more studies reported the outcomes of one-stage revisions. This systematic review aims to assess reinfection rate, infection-free survival after reoperation for recurrent infection, and the microorganisms involved in both primary and recurrent infection.
A systematic review of all studies reporting the outcome of one-stage revision for PJI of the knee up to September 2022, according to PRISMA criteria and AMSTAR2 guidelines, was performed. Patient demographics, clinical, surgical, and postoperative data were recorded.
CRD42022362767.
Eighteen studies with a total of 881 one-stage revisions for PJI of the knee were analyzed. A reinfection rate of 12.2% after an average follow-up of 57.6 months was reported. The most frequent causative microorganism were gram-positive bacteria (71.1%), gram-negative bacteria (7.1%), and polymicrobial infections (8%). The average postoperative knee society score was 81.5, and the average postoperative knee function score was 74.2. The infection-free survival after treatment for recurrent infection was 92.1%. The causative microorganisms at reinfections differed significantly from the primary infection (gram-positive 44.4%, gram-negative 11.1%).
Patients who underwent a one-stage revision for PJI of the knee showed a reinfection rate lower or comparable to other surgical treatments as two-stage or DAIR (debridement, antibiotics, and implant retention). Reoperation for reinfection demonstrates a lower success compared to one-stage revision. Moreover, microbiology differs between primary infection and recurrent infection. Level of evidence Level IV.
膝关节假体周围关节感染（PJI）是初次全膝关节置换术后 1.5%至 2%的严重并发症。尽管两阶段翻修被认为是膝关节 PJI 的金标准治疗方法，但在过去几十年中，更多的研究报告了单阶段翻修的结果。本系统评价旨在评估再感染率、再次感染后手术的无感染生存率以及初次感染和复发性感染中涉及的微生物。
根据 PRISMA 标准和 AMSTAR2 指南，对截至 2022 年 9 月报告膝关节 PJI 单阶段翻修结果的所有研究进行了系统评价。记录了患者人口统计学、临床、手术和术后数据。
CRD42022362767。
分析了 18 项研究，共 881 例膝关节 PJI 单阶段翻修。平均随访 57.6 个月后，报告再感染率为 12.2%。最常见的病原体为革兰阳性菌（71.1%）、革兰阴性菌（7.1%）和混合感染（8%）。术后平均膝关节学会评分 81.5，术后平均膝关节功能评分 74.2。复发性感染治疗后的无感染生存率为 92.1%。再感染的病原体与初次感染明显不同（革兰阳性 44.4%，革兰阴性 11.1%）。
膝关节 PJI 行单阶段翻修的患者再感染率低于或与两阶段或 DAIR（清创、抗生素和保留植入物）等其他手术治疗相当。再次感染的手术治疗成功率低于单阶段翻修。此外，初次感染和复发性感染的微生物学存在差异。证据水平为 IV 级。
