Song Sang Jun, Hwang Sung Hyun, Baek Hyun Jae, Park Cheol Hee
Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Korea.
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4996-5004. doi: 10.1007/s00167-023-07552-3. Epub 2023 Aug 29.
To investigate the aseptic survival of 1.5-stage exchange arthroplasty for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA).
Eighty-eight cases of 1.5-stage exchange arthroplasty for PJI without reinfection were retrospectively analysed. The autoclaved femoral component and new polyethylene insert (PE) were implanted using antibiotic mixed cement. The explanted tibial component was not reinserted. The Western Ontario and McMaster Universities Osteoarthritis Index and range of motion were clinically evaluated preoperatively and at the last follow-up (the last time for the implant in situ). Radiographically, hip-knee-ankle angle (HKA) and component positions were measured preoperatively, postoperatively (1 month after the 1.5-stage exchange arthroplasty), and at the last follow-up. The survival rate was analysed using the Kaplan-Meier method, in which failure was defined as reoperation due to aseptic failure. Mean period to failure and failure site were analysed. Factors affecting survival were investigated in terms of demographics and inappropriateness of the postoperative HKA (HKA > 0 ± 3°) and component positions (α angle > 95 ± 3°, β angle > 90 ± 3°, γ angle > 3 ± 3°, and δ angle > 87 ± 3°).
The spacer in-situ time was 3.7 years (0.2-6.4). The clinical results improved hip-knee-ankle significantly at the last follow-up. Radiographically, the average HKA was valgus 0.1° postoperatively. The average α, β, γ, and δ angles of the postoperative component positions were 95.9°, 90.4°, 3.8°, and 86.7°, respectively. The 1-, 2-, and 5-year postoperative survival rates were 90.9%, 86.4%, and 80.6%, respectively. The mean period to failure was 2.0 years (0.2-5.3). There were 18 cases of aseptic loosening (20.8%), occurring on both the femur and tibial sides in 1 knee, and only on the tibial side in 17 knees. Inappropriate coronal position of the PE (β angle > 90 ± 3°) was a significant factor affecting survival (odds ratio = 5.491; p = 0.011).
The aseptic survival of the 1.5-stage exchange arthroplasty was acceptable when using an autoclaved femoral component and new PE. The appropriate coronal position of the PE helps ensure favourable survival of 1.5-stage exchange arthroplasty.
IV.
探讨全膝关节置换术（TKA）后假体周围关节感染（PJI）行1.5期翻修置换术的无菌生存率。
回顾性分析88例行1.5期翻修置换术且未再次感染的PJI病例。采用抗生素混合骨水泥植入经高压灭菌的股骨组件和新的聚乙烯内衬（PE）。取出的胫骨组件不再重新植入。术前及末次随访（植入物在位的最后一次随访）时，采用西安大略和麦克马斯特大学骨关节炎指数及活动范围进行临床评估。通过影像学检查，术前、术后（1.5期翻修置换术后1个月）及末次随访时测量髋膝踝角（HKA）及组件位置。采用Kaplan-Meier法分析生存率，其中失败定义为因无菌性失败而行再次手术。分析平均失败时间及失败部位。从人口统计学特征以及术后HKA（HKA＞0±3°）和组件位置（α角＞95±3°、β角＞90±3°、γ角＞3±三°和δ角＞87±3°）不合适方面研究影响生存的因素。
间隔器在位时间为3.7年（0.2 - 6.4年）。末次随访时临床结果使髋膝踝情况显著改善。影像学检查显示，术后平均HKA为外翻0.1°。术后组件位置的平均α、β、γ和δ角分别为95.9°、90.4°、3.8°和86.7°。术后1年、2年和5年的生存率分别为90.9%、86.4%和80.6%。平均失败时间为2.0年（0.2 - 5.3年）。有18例无菌性松动（20.8%），其中1例膝关节股骨和胫骨侧均发生，17例膝关节仅胫骨侧发生。PE冠状位位置不合适（β角＞90±3°）是影响生存预后的显著因素（比值比=5.491；p = 0.011）。
使用经高压灭菌的股骨组件和新的PE时，1.5期翻修置换术的无菌生存率是可以接受的。PE合适的冠状位位置有助于确保1.5期翻修置换术有良好的生存率。
IV级。
