Faculty of Medicine, Tishreen University, Latakia, Syria.
Faculty of Medicine, Al-Baath University, Homs, Syria.
J Orthop Surg Res. 2024 Oct 12;19(1):643. doi: 10.1186/s13018-024-05152-6.
Periprosthetic joint infection (PJI) after total knee arthroplasty is a complication that affects approximately 2-3% of patients. The management of this issue is complicated and expensive for both the patients and the healthcare system. Multiple management options are available including antibiotic suppressive therapy, surgical management, and salvage procedures. Surgical management is considered a popular option for treating PJI, with multiple available surgical techniques, including single-stage revision arthroplasty and two-stage revision arthroplasty among others. Two-stage revision has been considered the gold standard for treating PJI. This method consists of two surgical procedures with a time interval in between, the first procedure aims to eradicate the infection along with implanting either a static or a mobile spacer, while the second intervention aims to remove the spacer and implant a new prothesis. During the interval period the patient is closely monitored through a handful of laboratory tests and clinical signs that help in assessing the optimal time of undertaking the second stage. However, in recent years, the single-stage method has gained much attention for its comparable outcomes and fewer complications. Contrary to the two-stage method, the single-stage approach consists only of one procedure in which the old infected prosthesis is removed and a new one is implanted. Many articles have compared the two methods over the years but have not agreed on a particular approach to be more potent in eliminating infection and providing better outcomes. Plenty of questions are yet to be answered regarding the two methods, including the superior type of spacer, interim period duration, and single-stage revision inclusion criteria. We herein, aim to address these issues, highlighting recent advances in managing this morbid complication and discussing controversial topics in the staged procedures.
全膝关节置换术后假体周围关节感染（PJI）是一种影响约 2-3%患者的并发症。该问题的治疗对患者和医疗保健系统来说都很复杂且昂贵。有多种管理选择，包括抗生素抑制治疗、手术治疗和挽救性手术。手术治疗被认为是治疗 PJI 的一种流行选择，有多种可用的手术技术，包括单阶段翻修和双阶段翻修等。双阶段翻修被认为是治疗 PJI 的金标准。该方法包括两个手术程序，其间有时间间隔，第一个程序旨在消除感染，同时植入静态或移动间隔器，第二个干预措施旨在去除间隔器并植入新的假体。在间隔期间，患者通过一系列实验室测试和临床体征进行密切监测，这些测试和体征有助于评估进行第二阶段的最佳时间。然而，近年来，单阶段方法因其可比的结果和较少的并发症而受到广泛关注。与双阶段方法不同，单阶段方法仅包括一个程序，即去除旧的感染假体并植入新的假体。多年来，许多文章比较了这两种方法，但对于哪种方法更能有效消除感染和提供更好的结果，尚未达成一致意见。关于这两种方法，还有很多问题需要回答，包括哪种类型的间隔器更好、间隔期持续时间以及单阶段翻修的纳入标准。我们旨在解决这些问题，重点介绍管理这种病态并发症的最新进展，并讨论分期手术中的争议性话题。
