Walmsley Phil J
Department of Orthopaedic Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy, UK.
School of Medicine, University of St Andrews, North Haugh, St Andrews, Fife, UK.
Ann Jt. 2022 Jan 15;7:7. doi: 10.21037/aoj-20-83. eCollection 2022.
Prosthetic joint infections remain an ongoing challenge for orthopaedic surgeons with an interest in knee arthroplasty, which relates to their often difficult diagnoses, need for multiple surgeries, increased technical and financial requirements. Peri-prosthetic joint infection is devastating complication for the patient and with the current literature unable to either demonstrate superiority of one or two stage revision then we should continue to assess on a case by case basis. The use of a '2 in 1' single-stage approach has been recently been promoted as a form of single stage revision for infection on account of the potential for reduction in risks, costs, and complications. Where it is safe to do so, a single stage procedure can avoid several of the drawbacks which may occur with a formal two stage approach. Particularly, it can reduce the risk of post-operative stiffness and arthrofibrosis which can be associated with two stage surgery. Use of a single stage may be more cost effective, by saving the patient having to undergo a second major procedure. This article reviews the indications for its use, technique and results. The use of '2-in-1' single-stage revision can be considered as an effective option for treating infection following TKR and cases with associated bone loss.
对于热衷于膝关节置换术的骨科医生而言，人工关节感染始终是一项持续存在的挑战，这与感染往往难以诊断、需要多次手术以及技术和资金需求增加有关。假体周围关节感染对患者来说是一种毁灭性的并发症，鉴于目前的文献无法证明一期或二期翻修术的优越性，我们应继续逐案评估。“二合一”单阶段方法最近作为一种感染单阶段翻修形式得到推广，因为它有可能降低风险、成本和并发症。在安全可行的情况下，单阶段手术可以避免正式两阶段手术可能出现的几个缺点。特别是，它可以降低与两阶段手术相关的术后僵硬和关节纤维性变的风险。采用单阶段手术可能更具成本效益，因为可以让患者不必接受第二次大手术。本文回顾了其使用指征、技术和结果。“二合一”单阶段翻修术可被视为治疗全膝关节置换术后感染及伴有相关骨质缺损病例的有效选择。
