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全膝关节置换术后假体周围关节感染的调查与处理:基于最新英国骨科协会标准和专业标准指南的更新

The Investigation and Management of Peri-Prosthetic Joint Infection After Total Knee Arthroplasty: An Update Based on the Latest British Orthopaedic Association Standard and Speciality Standard Guidelines.

作者信息

Doski Sizar, Sebastiao Alexandra, Thayaparan Prashant

机构信息

Emergency Medicine, Imperial College Healthcare NHS Trust, London, GBR.

Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, London, GBR.

出版信息

Cureus. 2024 Nov 9;16(11):e73315. doi: 10.7759/cureus.73315. eCollection 2024 Nov.

Abstract

Peri-prosthetic joint infection (PJI) is a significant complication following total knee arthroplasty (TKA). Early identification and management are essential to prevent severe morbidity and mortality in these patients. Long-term complications of PJI include the need for multiple operations, disability, joint stiffness, reduced range of motion, and increased mortality. Clinical signs, inflammatory markers, imaging, tissue sampling, and synovial fluid analysis are required to diagnose PJI. Debridement antibiotics and implant retention (DAIR) is an effective management option, but single- or two-stage exchange arthroplasty may be ultimately required. All cases of PJI in TKA must be discussed in a multi-disciplinary (MDT) meeting. This review incorporates the updated British Orthopaedic Association (BOA) standard and speciality standard to provide an up-to-date guideline on the early identification and management of PJI. We highlight that adhering to the BOA guidelines and adopting an MDT approach are essential for optimal patient outcomes.

摘要

人工关节周围感染(PJI)是全膝关节置换术(TKA)后的一种严重并发症。早期识别和处理对于预防这些患者的严重发病和死亡至关重要。PJI的长期并发症包括需要多次手术、残疾、关节僵硬、活动范围减小以及死亡率增加。诊断PJI需要临床体征、炎症标志物、影像学检查、组织采样和滑液分析。清创抗生素及保留植入物(DAIR)是一种有效的处理选择,但最终可能需要进行一期或二期关节置换术。TKA中所有PJI病例都必须在多学科(MDT)会议上进行讨论。本综述纳入了更新后的英国骨科协会(BOA)标准和专业标准,以提供关于PJI早期识别和处理的最新指南。我们强调,遵循BOA指南并采用MDT方法对于实现最佳患者结局至关重要。

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