Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany; Department of Orthopaedic Surgery, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Bagno A Ripoli (FI), Italy.
Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.
J Arthroplasty. 2024 Aug;39(8):2094-2099. doi: 10.1016/j.arth.2024.02.053. Epub 2024 Feb 23.
Intraoperative acquisition of representative tissue samples is essential during revision arthroplasty of the infected total knee arthroplasty (TKA). While the number of intraoperative tissue samples needed to identify the organism is well described in the literature, there is still a paucity of evidence regarding the location of positive intraoperative samples and their correlation to postoperative outcomes.
There were forty-two patients who had septic failure following one-stage revision TKA for periprosthetic joint infection who were identified between January 2009 and December 2017. They were matched to a control group of patients who had successful one-stage revision TKA without septic failure. The location of positive intraoperative tissue samples was categorized as: 1) soft tissue; 2) interface between bone and prosthesis; and 3) intramedullary (IM). Chi-square, Student's t-, and Wilcoxon Mann-Whitney U-tests were used as appropriate. Univariate and multivariate logistic regression analyses were performed to evaluate predictors of septic failure.
Weight > 100 kilograms (P = .033), higher Charlson Comorbidity Index (P < .001), and positive IM cultures (P < .001) were associated with a higher risk of reinfection after one-stage revision TKA. A positive IM sample carried a nearly five-fold increase in odds of reinfection (odds ratio 4.86, 95% confidence interval 1.85 to 12.78, P = .001).
A positive IM culture sample is significantly associated with septic failure after one-stage exchange for periprosthetic joint infection of the knee. Patients who had positive IM cultures may benefit from longer postoperative antibiotic therapy for the treatment of one-stage exchange arthroplasty to minimize the risk of reinfection.
在感染性全膝关节置换术（TKA）的翻修过程中，获取有代表性的组织样本是至关重要的。虽然文献中已经很好地描述了确定病原体所需的术中组织样本数量，但关于阳性术中样本的位置及其与术后结果的相关性，仍缺乏证据。
我们回顾性分析了 2009 年 1 月至 2017 年 12 月期间因假体周围关节感染行一期翻修 TKA 后发生感染失败的 42 例患者，并与同期行一期翻修 TKA 且无感染失败的对照组患者进行匹配。将阳性术中组织样本的位置分为：1）软组织；2）骨与假体界面；3）髓内（IM）。使用卡方检验、Student's t 检验和 Wilcoxon 秩和检验。采用单变量和多变量逻辑回归分析评估感染失败的预测因素。
体重>100 公斤（P=0.033）、Charlson 合并症指数较高（P<0.001）和 IM 培养阳性（P<0.001）与一期翻修 TKA 后再感染的风险增加相关。IM 样本阳性与再感染的可能性增加近五倍（比值比 4.86，95%置信区间 1.85 至 12.78，P=0.001）。
IM 培养阳性样本与膝关节假体周围感染一期翻修后感染失败显著相关。IM 培养阳性的患者可能受益于更长时间的术后抗生素治疗，以降低一期翻修关节置换术的再感染风险。
