Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany.
Bone Joint J. 2024 Jul 1;106-B(7):669-679. doi: 10.1302/0301-620X.106B7.BJJ-2023-0978.R2.
In cases of severe periprosthetic joint infection (PJI) of the knee, salvage procedures such as knee arthrodesis (KA) or above-knee amputation (AKA) must be considered. As both treatments result in limitations in quality of life (QoL), we aimed to compare outcomes and factors influencing complication rates, mortality, and mobility.
Patients with PJI of the knee and subsequent KA or AKA between June 2011 and May 2021 were included. Demographic data, comorbidities, and patient history were analyzed. Functional outcomes and QoL were prospectively assessed in both groups with additional treatment-specific scores after AKA. Outcomes, complications, and mortality were evaluated.
A total of 98 patients were included, 52 treated with arthrodesis and 47 with AKA. The mean number of revision surgeries between primary arthroplasty and arthrodesis or AKA was 7.85 (SD 5.39). Mean follow-up was 77.7 months (SD 30.9), with a minimum follow-up of two years. Complications requiring further revision surgery occurred in 11.5% of patients after arthrodesis and in 37.0% of AKA patients. Positive intraoperative tissue cultures obtained during AKA was significantly associated with the risk of further surgical revision. Two-year mortality rate of arthrodesis was significantly lower compared to AKA (3.8% vs 28.3%), with age as an independent risk factor in the AKA group. Functional outcomes and QoL were better after arthrodesis compared to AKA. Neuropathic pain was reported by 19 patients after AKA, and only 45.7% of patients were fitted or were intended to be fitted with a prosthesis. One-year infection-free survival after arthrodesis was 88.5%, compared to 78.5% after AKA.
Above-knee amputation in PJI results in high complication and mortality rates and poorer functional outcome compared to arthrodesis. Mortality rates after AKA depend on patient age and mobility, with most patients not able to be fitted with a prosthesis. Therefore, arthrodesis should be preferred whenever possible if salvage procedures are indicated.
在膝关节严重人工关节感染（PJI）的情况下，必须考虑膝关节融合术（KA）或膝上截肢术（AKA）等挽救性手术。由于这两种治疗方法都会导致生活质量（QoL）受限，我们旨在比较结果以及影响并发症发生率、死亡率和活动能力的因素。
纳入 2011 年 6 月至 2021 年 5 月间患有膝关节 PJI 并随后行 KA 或 AKA 的患者。分析人口统计学数据、合并症和病史。在两组患者中，前瞻性评估功能结局和 QoL，并在 AKA 后分别进行特定于治疗的评分。评估结局、并发症和死亡率。
共纳入 98 例患者，52 例接受融合术治疗，47 例接受 AKA 治疗。初次关节置换与融合术或 AKA 之间的平均翻修手术次数为 7.85（SD 5.39）。平均随访时间为 77.7 个月（SD 30.9），随访时间至少为两年。融合术后有 11.5%的患者和 AKA 术后有 37.0%的患者需要进一步翻修手术治疗并发症。在 AKA 术中获得的阳性组织培养物与进一步手术翻修的风险显著相关。融合术的两年死亡率明显低于 AKA（3.8%比 28.3%），AKA 组中年龄是独立的危险因素。与 AKA 相比，融合术后的功能结局和 QoL 更好。AKA 后有 19 例患者报告出现神经性疼痛，只有 45.7%的患者适合或打算配备假体。融合术后一年无感染生存率为 88.5%，AKA 术后为 78.5%。
与融合术相比，膝关节 PJI 行 AKA 会导致更高的并发症和死亡率，以及更差的功能结局。AKA 后的死亡率取决于患者的年龄和活动能力，大多数患者无法配备假体。因此，如果需要挽救性手术，应尽可能首选融合术。
