Pérez-Prieto Daniel, Pardo Albert, Fontanellas Albert, Gómez-Junyent Joan, Hinarejos Pedro, Monllau Joan-Carles
Hospital del Mar - Universitat Pompeu Fabra (UPF), Passeig Marítim, 25, Barcelona, Spain.
IcatKnee, Hospital Universitari Dexeus - Universitat Autònoma de Barcelona, Barcelona, Spain.
J Exp Orthop. 2023 Sep 25;10(1):96. doi: 10.1186/s40634-023-00656-2.
The primary aim of the present study is to report the late acute hematogenous (LAH) prosthetic joint infection (PJI) cure rate following Total knee arthroplasty (TKA) treated by means of debridement, antibiotics, and implant retention (DAIR) in a long-term follow-up. The secondary purpose is to report the functional outcomes at that follow-up and to compare them with a non-infected group.
This study cohort consists of 2,498 TKA performed from September 2005 to April 2010 that had a minimum follow-up of 10 years. The diagnosis of PJI and classification into LAH was done in accordance with the Zimmerli criteria. The primary outcome was the failure rate, defined as death before the end of antibiotic treatment, a further surgical intervention for treatment of infection, life-long antibiotic suppressive treatment or chronic infection. The Knee Society Score (KSS) was used to evaluate clinical outcomes.
Ten patients were diagnosed with acute hematogenous PJI during the study period (0.4%). All of them were managed with DAIR, which was performed by a knee surgeon and/or PJI surgeon. The failure rate was 0% at the 8.5-year (SD, 2.4) follow-up mark. The KSS score was 82.1 vs. 84.1 (p n.s.) at final follow-up.
Although the literature suggests that TKA DAIR for LAH periprosthetic joint infection is associated with high rates of failure, the results presented here suggest a high cure rate with good functional outcomes.
Level II, prospective cohort study.
本研究的主要目的是报告在长期随访中，全膝关节置换术（TKA）后采用清创、抗生素和保留植入物（DAIR）治疗的晚期急性血源性（LAH）人工关节感染（PJI）的治愈率。次要目的是报告该随访时的功能结果，并与未感染组进行比较。
本研究队列包括2005年9月至2010年4月期间进行的2498例TKA，其最短随访时间为10年。PJI的诊断及LAH的分类依据齐默利标准进行。主要结局为失败率，定义为抗生素治疗结束前死亡、因感染进行进一步手术干预、终身抗生素抑制治疗或慢性感染。采用膝关节协会评分（KSS）评估临床结局。
在研究期间，10例患者被诊断为急性血源性PJI（0.4%）。所有患者均接受了DAIR治疗，由膝关节外科医生和/或PJI外科医生进行操作。在8.5年（标准差，2.4）的随访时间点，失败率为0%。最终随访时，KSS评分为82.1，而与之对比的未感染组评分为84.1（p值无统计学意义）。
尽管文献表明TKA的DAIR治疗LAH假体周围关节感染的失败率较高，但本研究结果显示治愈率较高且功能结局良好。
二级，前瞻性队列研究。
