Grünther Ralf-Achim
Orthopädie und Unfallchirurgie, Diakonie Klinikum Südwestfalen - Krankenhaus Bethesda, Euelsbruchstraße 39, 57258, Freudenberg, Deutschland.
Unfallchirurgie (Heidelb). 2024 Sep;127(9):620-625. doi: 10.1007/s00113-024-01469-3. Epub 2024 Aug 13.
In the evaluation of an internal analysis of data on the increased effort for nursing during rehabilitation of patients with amputations in the Baumrainklinik of the HELIOS Rehabilitation Center Bad Berleberg, the number of patients with transfemoral amputations (TFA) due to uncontrollable multiple infections after implantation of a total knee endoprosthesis (total knee arthroplasty, TKA) was clearly emphasized.
This article discusses the results of a retrospective, patient-controlled trial (PCT) and compares these with the data of the German Endoprosthesis Registry (EPRD). The study concentrated on patients who were admitted to rehabilitation after a TFA due to an uncontrollable infection after implantation of a knee TKA. The primary aims were the identification of patients who developed an uncontrollable infection after TKA with subsequent TFA and the comparison with national and international revision and amputation rates after TKA.
An analysis of the medical history questionnaire was carried out for all 787 patients with amputation of the lower extremities who underwent rehabilitation in the time period from 1st January 2007 to 31st December 2015. The patient records were systematically analyzed based on the standardized documentation methods of the medical and nursing personnel using the Barthel index, the activity/function classes, phantom pain and length of stay, including demography, infection history and insurance company.
The analysis showed that 10 patients, 2.29% of all TFA, suffered the loss of a lower extremity due to an uncontrollable TKA infection. The revision rate 3 years after primary TKA in Germany is 3.0% (EPRD annual report 2023), whereas values of 1-4% are given in the international literature (status 2020). In the patient group of the EPRD, in 2022 revision surgery was necessary due to an infection in 15.0% of the cases. The current statistics of the EPRD (annual report 2023) show that 3 years after the initial revision surgery due to an infected TKA another revision was necessary in 23.5-30% of cases.
These numbers are alarming and should be critically evaluated and monitored. The future aim is to identify the causes of infections, systematic errors in the TKA and the pathogens that lead to infections after TKA and to correlate the associations.
在对黑利奥斯巴特贝雷伯格康复中心鲍姆兰克林诊所截肢患者康复期间护理工作增加的数据进行内部分析评估时，因全膝关节置换术后（全膝关节置换术，TKA）出现无法控制的多重感染而导致经股截肢（TFA）的患者数量被显著凸显出来。
本文讨论了一项回顾性患者对照试验（PCT）的结果，并将其与德国人工关节登记处（EPRD）的数据进行比较。该研究集中于因膝关节TKA植入后出现无法控制的感染而接受TFA康复治疗的患者。主要目的是确定TKA后出现无法控制的感染并随后进行TFA的患者，并与TKA后的国内和国际翻修率及截肢率进行比较。
对2007年1月1日至2015年12月31日期间在该中心接受康复治疗的所有787例下肢截肢患者的病史问卷进行分析。根据医护人员的标准化记录方法，使用巴氏指数、活动/功能分级、幻肢痛和住院时间，对患者记录进行系统分析，包括人口统计学、感染史和保险公司信息。
分析显示，10例患者（占所有TFA的2.29%）因无法控制的TKA感染而失去下肢。德国初次TKA后3年的翻修率为3.0%（EPRD 2023年年报），而国际文献中的数值为1 - 4%（2020年数据）。在EPRD的患者组中，2022年因感染而需要进行翻修手术的病例占15.0%。EPRD的当前统计数据（2023年年报）显示，因感染性TKA进行初次翻修手术后3年，23.5 - 30%的病例需要再次翻修。
这些数字令人担忧，应进行严格评估和监测。未来的目标是确定感染的原因、TKA中的系统错误以及导致TKA后感染的病原体，并关联这些因素之间的关系。
