胫骨结节截骨术在翻修全膝关节置换治疗假体周围感染中的应用：适应证与疗效。
Tibial Tubercle Osteotomy in Revision Total Knee Arthroplasty for Periprosthetic Infection: Indications and Outcomes.
机构信息
Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France.
IFSTTAR, LBMC UMR_T9406, Université Claude Bernard Lyon 1, Université Lyon, Villeurbanne, France.
出版信息
J Bone Joint Surg Am. 2023 Nov 15;105(22):1768-1776. doi: 10.2106/JBJS.23.00256. Epub 2023 Jul 12.
BACKGROUND
Adequate exposure is essential in revision total knee arthroplasty (RTKA). Tibial tubercle osteotomy (TTO) enhances exposure, but its use is controversial in the setting of periprosthetic infection. The purposes of this study were to determine (1) the rates of complications and revisions due to TTO during RTKA in the setting of a periprosthetic infection, (2) the rate of septic failure, and (3) functional outcomes at a minimum 2-year follow-up.
METHODS
A single-center retrospective study from 2010 to 2020 was performed. The cases of a total of 68 patients who received a TTO during RTKA in the setting of periprosthetic infection with a minimum follow-up of 2 years (mean, 53.3 months; range, 24 to 117 months) were analyzed. Complications and revisions due to TTO were reported. The functional outcomes were assessed using the Knee Society Score (KSS) and range of motion.
RESULTS
Seven knees (10.3%) had complications secondary to the TTO (3 had fracture-displacement of the TTO; 2, nonunion; 1, delayed union; and 1, wound dehiscence). The mean time to union (and standard deviation) was 3.8 ± 3.2 months (range, 1.5 to 24 months). Two knees (2.9%) underwent a TTO-related revision (1 had wound debridement, and 1 had tibial tubercle osteosynthesis). Eighteen knees (26.5%) had recurrence of infection requiring revision: 17 were managed with debridement, antibiotics, and implant retention (DAIR), and 1 had 2-stage RTKA. Flexion improved after surgery (from a mean of 70° to a mean of 86°; p = 0.009), as did the KSS knee (46.6 to 79; p < 0.001) and function (35.3 to 71.5; p < 0.001) subscores. Overall, 42.6% of infected knees managed with RTKA with the TTO procedure were considered successful without any complication at the last follow-up. Only 2 knees (2.9%) required revision related to the TTO.
CONCLUSIONS
TTO in RTKA involving periprosthetic infection is an effective surgical exposure aid and has excellent rates of union (97.1%) despite the presence of infection. However, the risk of failure because of persistent or recurrent infection remains high in the first 2 years following RTKA for infection.
LEVEL OF EVIDENCE
Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
背景
在翻修全膝关节置换术（RTKA）中，充分的显露至关重要。胫骨结节截骨术（TTO）可增强显露，但在假体周围感染的情况下，其使用存在争议。本研究的目的是确定：（1）在假体周围感染的情况下，RTKA 中 TTO 相关并发症和翻修的发生率；（2）感染性失败的发生率；（3）至少 2 年随访时的功能结果。
方法
对 2010 年至 2020 年期间在假体周围感染情况下接受 TTO 的 68 例患者进行了单中心回顾性研究，随访时间至少为 2 年（平均 53.3 个月；范围，24 至 117 个月）。报告了 TTO 相关的并发症和翻修。使用膝关节学会评分（KSS）和关节活动度评估功能结果。
结果
7 例（10.3%）膝关节因 TTO 出现并发症（3 例 TTO 发生骨折-移位，2 例发生骨不连，1 例发生延迟愈合，1 例发生切口裂开）。平均愈合时间（及标准差）为 3.8 ± 3.2 个月（范围，1.5 至 24 个月）。2 例（2.9%）膝关节因 TTO 相关原因行翻修（1 例行切口清创，1 例行胫骨结节内固定）。18 例（26.5%）膝关节出现感染复发，需要翻修：17 例采用清创、抗生素和保留假体（DAIR）治疗，1 例行二期 RTKA。术后膝关节屈曲度改善（从平均 70°改善至平均 86°；p = 0.009），KSS 膝关节评分（从 46.6 改善至 79；p < 0.001）和功能评分（从 35.3 改善至 71.5；p < 0.001）也有改善。总的来说，在最后一次随访时，接受 RTKA 联合 TTO 手术治疗的感染膝关节中，42.6%被认为是成功的，没有任何并发症。仅 2 例（2.9%）膝关节因 TTO 相关问题需要翻修。
结论
在假体周围感染的 RTKA 中，TTO 是一种有效的手术显露辅助方法，尽管存在感染，但愈合率很高（97.1%）。然而，在感染行 RTKA 后的前 2 年，因持续性或复发性感染而导致失败的风险仍然很高。
证据等级
治疗性 IV 级。请参阅作者须知，以获取完整的证据等级描述。
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