Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Orthop Traumatol. 2024 Feb 12;25(1):6. doi: 10.1186/s10195-024-00750-w.
The cause of early septic failure after two-stage exchange revision total knee arthroplasty (TKA) for chronic periprosthetic joint infection (PJI) and the factors affecting it are not well known. The purpose of this study was to determine the surgical outcomes and the risk factors for early septic failure after two-stage revision TKA for chronic PJI.
We identified a total of 246 adult patients who met the Musculoskeletal Infection Society (MSIS) diagnostic criteria for chronic PJI at two academic tertiary hospitals from March 2012 to December 2018. Finally, 151 patients who consecutively received two-stage exchange revision TKA for chronic PJI and who had a minimum 3-year follow-up were enrolled and retrospectively reviewed. Successful surgical treatment was evaluated for two-stage revision TKA and risk factors for early septic failure were identified.
Early septic failures occurred within 3 years after reimplantation in 48 patients (31.8%). After accounting for potentially confounding variables, we found that male patient [odds ratio (OR): 2.753, 95% confidence interval (CI) 1.099-6.893, p = 0.031], fungus or mycobacterial infection (OR: 5.224, 95% CI 1.481-18.433, p = 0.01), and positive culture at reimplantation (OR: 4.407, 95% CI 1.255-15.480, p = 0.021) were independently associated with early septic failure after two-stage exchange revision TKA.
Male patients, fungus or mycobacterial infection, and positive culture at reimplantation were independently associated with an increased risk of early septic failure after two-stage exchange revision TKA despite normal C-reactive protein values prior to reimplantation. Further prospective and high-quality studies are needed to determine the risk factors of two-stage exchange revision TKA for chronic PJI.
level IV; retrospective comparison; treatment study.
对于慢性假体周围关节感染（PJI）的两阶段翻修全膝关节置换术（TKA）后早期败血症失败的原因及其影响因素尚不清楚。本研究的目的是确定两阶段翻修 TKA 治疗慢性 PJI 后早期败血症失败的手术结果和危险因素。
我们在两家学术性三级医院中确定了总共 246 名符合肌骨骼感染协会（MSIS）慢性 PJI 诊断标准的成年患者。最终，我们纳入并回顾性分析了 151 名连续接受两阶段翻修 TKA 治疗慢性 PJI 且随访时间至少 3 年的患者。对两阶段翻修 TKA 的手术治疗效果进行评估，并确定早期败血症失败的危险因素。
在再植入后 3 年内，48 名患者（31.8%）发生早期败血症失败。在考虑了潜在的混杂变量后，我们发现男性患者[比值比（OR）：2.753，95%置信区间（CI）1.099-6.893，p=0.031]，真菌感染或分枝杆菌感染（OR：5.224，95%CI 1.481-18.433，p=0.01）和再植入时的阳性培养（OR：4.407，95%CI 1.255-15.480，p=0.021）与两阶段翻修 TKA 后早期败血症失败独立相关。
尽管在再植入前 C 反应蛋白值正常，但男性患者、真菌感染或分枝杆菌感染以及再植入时的阳性培养与两阶段翻修 TKA 后早期败血症失败的风险增加独立相关。需要进一步进行前瞻性和高质量的研究来确定慢性 PJI 的两阶段翻修 TKA 的危险因素。
四级；回顾性比较；治疗研究。
