Koch Kevin-Arno, Spranz David M, Westhauser Fabian, Bruckner Tom, Lehner Burkhard, Alvand Abtin, Merle Christian, Walker Tilman
Department of Orthopaedic Surgery, University Hospital of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany.
J Clin Med. 2023 Aug 25;12(17):5542. doi: 10.3390/jcm12175542.
(1) Background: In the treatment of periprosthetic joint infection (PJI), the individual host status and previous surgical procedures appear to have a relevant influence on success rates and clinical outcome of knee revision surgery. Current data about the predictive value are limited in this subgroup of patients. (2) Methods: Retrospectively, 107 patients (109 knees) undergoing two-stage exchange knee arthroplasty for PJI using a rotating-hinge design with at least two years follow-up. The cumulative incidence (CI) for different endpoints was estimated with death as competing risk. Univariate and multivariate analyses for potential predictive factors were performed. Patient-related outcome measures (PROMs) for clinical outcome were evaluated. (3) Results: At 8 years, the CI of any revision was 29.6%, and of any reoperation was 38.9%. Significant predictors for risk of re-revision were the Charlson Comorbidity Index (CCI) and the number of previous surgical procedures prior to explanation of the infected implant. The functional and clinical outcome demonstrated acceptable results in the present cohort with a high comorbidity level. (4) Conclusions: A compromised host status and multiple previous surgical procedures were identified as negative predictors for re-revision knee surgery in the treatment of PJI. Reinfection remained the major reason for re-revision. Overall mortality was high.
(1) 背景：在人工关节周围感染（PJI）的治疗中，个体宿主状态和既往手术操作似乎对膝关节翻修手术的成功率和临床结果有相关影响。目前关于这一亚组患者预测价值的数据有限。(2) 方法：回顾性分析107例（109膝）因PJI接受两阶段翻修膝关节置换术且采用旋转铰链设计、随访至少两年的患者。以死亡作为竞争风险估计不同终点的累积发生率（CI）。对潜在预测因素进行单因素和多因素分析。评估临床结果的患者相关结局指标（PROMs）。(3) 结果：8年时，任何翻修的CI为29.6%，任何再次手术的CI为38.9%。再次翻修风险的显著预测因素为Charlson合并症指数（CCI）和感染植入物取出术前的既往手术次数。在本高合并症水平队列中，功能和临床结果显示可接受。(4) 结论：宿主状态不佳和既往多次手术被确定为PJI治疗中膝关节再次翻修手术的阴性预测因素。再次感染仍然是再次翻修的主要原因。总体死亡率较高。
