Şenel Ahmet, Öztürkmen Yusuf, Eren Murat, Carkci Engin, Circi Esra, Kanay Enes, Açıkgöz İlhan
Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, TUR.
Cureus. 2023 Jul 27;15(7):e42566. doi: 10.7759/cureus.42566. eCollection 2023 Jul.
Introduction Infection is one of the most distressing complications of total knee arthroplasty (TKA), requiring a long treatment process and may negatively affect patient satisfaction. All surgeons aim to achieve infection-free survival, painless, functional, and stable knee after treatment of periprosthetic joint infection (PJI) with two-stage revision treatment. Many factors play a role in determining clinical outcomes. We aimed to evaluate the factors influencing the clinical outcomes of patients undergoing two-stage revision knee arthroplasty for PJI. Methods Forty-nine patients were retrospectively evaluated. Forty-four patients met the inclusion criteria. Spacer types, growth rates in culture, types and amount of antibiotics added to the cement, and intervals between stages were evaluated. Pre- and post-treatment infection parameters, changes in the range of motion (ROM), clinical and functional (C&F) Knee Society Score (KSS) results, and complications were also studied. Results After a mean follow-up of 48.8 ± 16.5 months, re-infection was detected in five out of 44 patients (10.4%). No significant difference was noted regarding C&F KSS when comparing time intervals between the two stages, whether they were shorter or longer than 10 weeks. However, better ROM results were obtained in patients with less than 10 weeks between stages. The relationship between spacer type, ROM, and C&F KSS was not found to be significant. Particularly, the addition of 4g of teicoplanin to the cement shortened the time between the two stages. Conclusion C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels can be considered safe parameters for diagnosis, reimplantation timing, and follow-up. The use of dynamic spacers or reimplantation performed within 10 weeks after the first stage is associated with better ROM outcomes. Additionally, the addition of teicoplanin to the cement shortened the duration of antibiotic therapy.
引言
感染是全膝关节置换术（TKA）最令人困扰的并发症之一，治疗过程漫长，可能会对患者满意度产生负面影响。所有外科医生都致力于通过两阶段翻修治疗实现假体周围关节感染（PJI）治疗后无感染存活、无痛、功能良好且稳定的膝关节。许多因素在决定临床结果中起作用。我们旨在评估影响接受PJI两阶段翻修膝关节置换术患者临床结果的因素。
方法
对49例患者进行回顾性评估。44例患者符合纳入标准。评估了间隔器类型、培养中的生长速率、添加到骨水泥中的抗生素类型和数量以及阶段之间的间隔。还研究了治疗前后的感染参数、活动范围（ROM）变化、临床和功能（C&F）膝关节协会评分（KSS）结果以及并发症。
结果
平均随访48.8±16.5个月后，44例患者中有5例（10.4%）检测到再次感染。比较两个阶段之间的时间间隔，无论其短于还是长于10周，C&F KSS均未发现显著差异。然而，阶段间隔少于10周的患者获得了更好的ROM结果。未发现间隔器类型、ROM和C&F KSS之间的关系具有显著性。特别是，向骨水泥中添加4g替考拉宁缩短了两个阶段之间的时间。
结论
C反应蛋白（CRP）和红细胞沉降率（ESR）水平可被视为诊断、再次植入时机和随访的安全参数。使用动态间隔器或在第一阶段后10周内进行再次植入与更好的ROM结果相关。此外，向骨水泥中添加替考拉宁缩短了抗生素治疗的持续时间。
