Sax Florian Hubert, Fink Bernd
Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
Orthopaedic Department, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Antibiotics (Basel). 2023 Jul 6;12(7):1153. doi: 10.3390/antibiotics12071153.
Synovitis, like that associated with chronic bacterial arthritis, is a very rare finding during the implantation of knee endoprostheses. In such cases, we fix the knee prostheses with cement containing two antibiotics and carry out a course of systemic antibiotic administration. The aim was to analyze these cases for incidence, detection of bacteria, risk factors, and outcome.
Out of 7534 knee replacements between January 2013 and December 2020, 25 cases were suspected during the surgical procedure to have suffered from bacterial arthritis and were treated accordingly. Total synovectomy was carried out, whereby five intraoperative synovial samples were examined bacteriologically, and the complete synovitis was analyzed histologically. The mean follow-up was 65.3 ± 27.1 (24-85) months.
In nine cases (0.12%), the diagnosis of bacterial arthritis was made histologically and by clinical chemistry (elevated CRP), and in two of these cases, pathogen verification was performed. Eight of these nine patients had previously had injections or surgery associated with the corresponding knee joint or had an underlying immunomodulatory disease. None of the patients developed a periprosthetic infection at a later stage.
With an incidence of 0.12%, it is rare to unexpectedly detect bacterial synovitis during surgery. Total synovectomy, use of bone cement with two antibiotics, and immediate systemic antibiotic therapy seem to keep the risk of periprosthetic infection low.
滑膜炎，如与慢性细菌性关节炎相关的滑膜炎，在膝关节假体植入过程中是非常罕见的发现。在这种情况下，我们用含两种抗生素的骨水泥固定膝关节假体，并进行一个疗程的全身抗生素给药。目的是分析这些病例的发病率、细菌检测、危险因素及预后。
在2013年1月至2020年12月期间的7534例膝关节置换手术中，有25例在手术过程中疑似患有细菌性关节炎并接受了相应治疗。进行了全滑膜切除术，术中对5份滑膜样本进行了细菌学检查，并对完整的滑膜炎进行了组织学分析。平均随访时间为65.3±27.1（24 - 85）个月。
9例（0.12%）经组织学和临床化学检查（CRP升高）确诊为细菌性关节炎，其中2例进行了病原体鉴定。这9例患者中有8例此前曾进行过与相应膝关节相关的注射或手术，或患有潜在的免疫调节疾病。所有患者后期均未发生假体周围感染。
手术中意外检测到细菌性滑膜炎的发生率为0.12%，较为罕见。全滑膜切除术、使用含两种抗生素的骨水泥以及立即进行全身抗生素治疗似乎可使假体周围感染风险保持较低水平。
