Kim Sang-Gyun, Kim Hwa Pyung, Bae Ji Hoon
Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea.
J Bone Joint Surg Am. 2024 Jan 17;106(2):158-168. doi: 10.2106/JBJS.23.00519. Epub 2023 Nov 7.
Although several studies have compared the clinical outcomes of septic and aseptic revision total knee arthroplasty (TKA), their results have been controversial. Therefore, this study aimed to compare clinical outcomes and complications of septic and aseptic revision TKA through a systematic review and meta-analysis.
The PubMed (MEDLINE) and Embase databases were searched for studies evaluating the clinical outcomes and complications of 2-stage septic revision and aseptic revision TKAs. A systematic review of clinical outcomes (Knee Society Knee and Function Scores and range of motion) and complications (reoperation, infection, and failure rates) was conducted.
Thirteen studies were included in the systematic review. The mean MINORS (Methodological Index for NOn-Randomized Studies) score of the included studies was 20.5 (range, 18 to 22). The meta-analysis revealed higher reoperation (risk ratio [RR], 1.98; 95% confidence interval [CI], 1.50 to 2.62; p < 0.00001), infection (RR, 4.08; 95% CI, 2.94 to 5.64; p < 0.00001), and failure rates (RR, 2.88; 95% CI, 1.38 to 6.03; p = 0.005) in septic revision TKAs than in aseptic revision TKAs. Moreover, septic revision TKAs showed lower Knee Society Knee Scores compared with aseptic TKAs (mean difference [MD], -6.86; 95% CI, -11.80 to -1.92; p = 0.006). However, the Knee Society Function Score (MD, -1.84; 95% CI, -7.84 to 3.80; p = 0.52) and range of motion (MD, -6.96°; 95% CI, -16.23° to 2.31°; p = 0.14) were not significantly different between septic and aseptic revision TKAs.
Despite the heterogeneity of prosthesis designs and surgical protocols used in septic and aseptic revision TKAs, the results of this systematic review suggest that 2-stage septic revision TKAs have poorer clinical outcomes and higher complication rates than aseptic revision TKAs do.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
尽管多项研究比较了感染性和无菌性翻修全膝关节置换术（TKA）的临床结果，但其结果仍存在争议。因此，本研究旨在通过系统评价和荟萃分析比较感染性和无菌性翻修TKA的临床结果及并发症。
检索PubMed（MEDLINE）和Embase数据库，查找评估两阶段感染性翻修和无菌性翻修TKA临床结果及并发症的研究。对临床结果（膝关节协会膝关节和功能评分以及活动范围）和并发症（再次手术、感染和失败率）进行系统评价。
系统评价纳入了13项研究。纳入研究的平均MINORS（非随机研究方法学指数）评分为20.5（范围为18至22）。荟萃分析显示，感染性翻修TKA的再次手术率（风险比[RR]，1.98；95%置信区间[CI]，1.50至2.62；p<0.00001）、感染率（RR，4.08；95%CI，2.94至5.64；p<0.00001）和失败率（RR，2.88；95%CI，1.38至6.03；p = 0.005）均高于无菌性翻修TKA。此外，与无菌性TKA相比，感染性翻修TKA的膝关节协会膝关节评分更低（平均差[MD]，-6.86；95%CI，-11.80至-1.92；p = 0.006）。然而，感染性和无菌性翻修TKA之间的膝关节协会功能评分（MD，-1.84；95%CI，-7.84至3.80；p = 0.52）和活动范围（MD，-6.96°；95%CI，-16.23°至2.31°；p = 0.14）无显著差异。
尽管感染性和无菌性翻修TKA中使用的假体设计和手术方案存在异质性，但本系统评价结果表明，两阶段感染性翻修TKA的临床结果比无菌性翻修TKA更差，并发症发生率更高。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
