Ortega-Yago Amparo, Pedraza-Corbi Aranza, Boadas-Gironès Laia, Lakhani Kushal, Sabater-Martos Marta, Corona Pablo S, Baixauli-García Ignacio, Argüelles-Linares Francisco, Baeza-Oliete Jose
Osteoarticular Infection Unit, Hospital Universitari i Politècnic la Fe, Valencia, Spain.
Servicio Cirurgia Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain.
J Arthroplasty. 2025 Jul;40(7):1845-1851. doi: 10.1016/j.arth.2024.12.009. Epub 2024 Dec 10.
Knee arthrodesis is a means of avoiding above-knee amputation after a periprosthetic joint infection (PJI). The objective of this study was to analyze the results of floating knee arthrodesis in patients who had a history of a periprosthetic knee infection and to perform an external validation of the Baeza-Ortega scale. The analysis consisted of determining reinfection rates, functional results, and the survival of arthrodesis.
There were 86 patients who had undergone floating knee arthrodesis in cases of PJI who were retrospectively included in the study. The operations were performed between 2012 and 2022 at three different referral centers for complex bone and joint infections in Spain. In addition to being evaluated clinically, analytically, and radiographically, the patients were assessed functionally with the Baeza-Ortega scale, which had been previously validated. At a mean follow-up of 4 years (range, 1 to 9), 13 patients suffered reinfection (15%) and 29% of patients experienced complications with an average of 42 months until a complication appeared.
The recurrence of infection was not observed to be significantly affected by sex (P = 0.13), age (P = 0.1), or the type of surgery previously undergone (P = 0.17), nor was the McPherson Host Grade (P = 0.4) observed to have a significant effect. Patients who had a McPherson Limb Grade 3 were more likely to suffer reinfection than those with a McPherson Limb Grade 2 (P = 0.036). There were 45 patients (53%) who were fully evaluated and scored. For 16 patients (35%), the results were evaluated as excellent, for 22 (48%) acceptable, for six (14%) low, and for one (3%) poor. There was a significant correlation between patient satisfaction and functional outcomes (P = 0.0006).
The arthrodesis nail without bone-bone fusion is an effective and safe procedure for patients who have a recurrent PJI, providing satisfactory functional results when a knee prosthesis revision cannot be performed.
膝关节融合术是避免人工关节周围感染（PJI）后进行膝上截肢的一种方法。本研究的目的是分析有膝关节假体周围感染病史的患者行浮动膝关节融合术的结果，并对贝萨 - 奥尔特加量表进行外部验证。分析内容包括确定再感染率、功能结果和融合术的生存率。
本研究回顾性纳入了86例行PJI相关浮动膝关节融合术的患者。手术于2012年至2022年在西班牙三个不同的复杂骨与关节感染转诊中心进行。除了进行临床、分析和影像学评估外，还使用先前已验证的贝萨 - 奥尔特加量表对患者进行功能评估。平均随访4年（范围1至9年），13例患者发生再感染（15%），29%的患者出现并发症，并发症出现的平均时间为42个月。
未观察到感染复发受性别（P = 0.13）、年龄（P = 0.1）或先前接受的手术类型（P = 0.17）的显著影响，麦克弗森宿主分级（P = 0.4）也未观察到有显著影响。麦克弗森肢体分级为3级的患者比肢体分级为2级的患者更易发生再感染（P = 0.036）。45例患者（53%）得到了全面评估和评分。16例患者（35%）的结果被评为优秀，22例（48%）可接受，6例（14%）低，1例（3%）差。患者满意度与功能结果之间存在显著相关性（P = 0.0006）。
对于复发性PJI患者，无骨 - 骨融合的融合钉是一种有效且安全的手术方法，在无法进行膝关节假体翻修时可提供令人满意的功能结果。
