Lin Yu-Chih, Chen Jui-Ping, Lee Sheng-Hsun, Chang Chih-Hsiang, Hu Chih-Chien, Lin Sheng-Hsuan
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital (CGMH), Taoyuan, Taiwan; Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital (CGMH), Taoyuan, Taiwan; College of Medicine, Chang Gung University (CGU), Taoyuan, Taiwan; Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital (CGMH), Taoyuan, Taiwan; College of Medicine, Chang Gung University (CGU), Taoyuan, Taiwan; New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan.
J Arthroplasty. 2025 Mar;40(3):765-772. doi: 10.1016/j.arth.2024.08.049. Epub 2024 Sep 3.
The clinical challenge of unexpected positive intraoperative cultures (UPICs) persists in 2-stage resection arthroplasty for managing periprosthetic joint infections (PJIs) following total knee arthroplasty.(TKA). This study aimed to investigate the incidence of UPICs during the definitive reimplantation phase of 2-stage resection arthroplasty of the knee and to assess both the infection-free and revision-free survivorship of the implanted prosthesis.
This retrospective study included 450 2-stage resection arthroplasties of primary knee prostheses performed between January 2012 and April 2017. Patients were excluded if they: (1) underwent three or more staged resections, (2) had ambiguous clinical documentation or deviated from the 2-stage protocol, or (3) underwent revision arthroplasty prior to the PJI. Additionally, patients presumed aseptic before the second-stage reimplantation were excluded if they lacked joint aspiration or met the 2011 Musculoskeletal Infection Society criteria for PJI before implantation.
After exclusions, 300 patients were analyzed. Among them, 14% had UPIC during the second-stage reimplantation. The follow-up time was 2,316 (range, 1,888 to 3,737) days and 2,531 (range, 1,947 to 3,349) days for UPIC and negative intraoperative culture (NIC) groups, respectively. Rerevision due to subsequent PJI occurred in 26.2% of UPIC patients and 15.1% of NIC patients. The 2-year infection-free survival rates for the NIC, one UPIC, and ≥ two UPIC cohorts were 99.5, 98.2, and 94.3%, respectively, while the 5-year survival rates were 92.1, 91.1, and 54.3%, respectively. The unfavorable survivorship was significantly different in multiple UPIC cases (P < 0.001). Multiple UPICs with pathogens consistent with the first-stage findings were strongly associated with the risk of reinfection (P < 0.001).
An UPIC was identified in 14% of second-stage reimplantations. Patients who had multiple UPICs demonstrated truncated survivorship and suboptimal outcomes relative to the NIC and single UPIC cohorts, especially with pathogen consistency to the first-stage surgery.
III.
在全膝关节置换术（TKA）后用于治疗假体周围关节感染（PJI）的两阶段切除关节成形术中，意外的术中培养阳性（UPIC）的临床挑战依然存在。本研究旨在调查膝关节两阶段切除关节成形术确定性再植入阶段UPIC的发生率，并评估植入假体的无感染和无翻修生存率。
这项回顾性研究纳入了2012年1月至2017年4月期间进行的450例原发性膝关节假体两阶段切除关节成形术。如果患者有以下情况则被排除：（1）接受了三次或更多次分期切除；（2）临床记录不明确或偏离两阶段方案；或（3）在PJI之前接受了翻修关节成形术。此外，如果在二期再植入前被认为无菌的患者缺乏关节穿刺抽吸，或在植入前符合2011年肌肉骨骼感染学会的PJI标准，也将被排除。
排除后，对300例患者进行了分析。其中，14%的患者在二期再植入时有UPIC。UPIC组和术中培养阴性（NIC）组的随访时间分别为2316天（范围1888至3737天）和2531天（范围1947至3349天）。因随后的PJI而进行再次翻修的情况在UPIC患者中占26.2%，在NIC患者中占15.1%。NIC组、一次UPIC组和≥两次UPIC组的2年无感染生存率分别为99.5%、98.2%和94.3%，而5年生存率分别为92.1%、91.1%和54.3%。多次UPIC病例的不良生存率有显著差异（P<0.001）。多次UPIC且病原体与一期结果一致与再次感染风险密切相关（P<0.001）。
在14%的二期再植入中发现了UPIC。与NIC组和单次UPIC组相比，有多次UPIC的患者生存率缩短且结果不理想，尤其是病原体与一期手术一致时。
III级
