Erne Felix, Grünwald Leonard, Histing Tina, Hemmann Philipp
Siegfried Weller Research Institute, BG Unfallklinik Tuebingen, Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
Department of Orthopedics and Traumatology, Diakonie-Klinikum Hospital, Rosenbergstr. 38, 70176 Stuttgart, Germany.
Microorganisms. 2025 Jul 18;13(7):1690. doi: 10.3390/microorganisms13071690.
Proximal tibial fractures can lead to post-traumatic osteoarthritis (PTOA), and subsequent total knee arthroplasty (TKA) in such patients is associated with elevated complication rates. A two-stage approach, involving the elective removal of osteosynthetic hardware prior to TKA, is recommended. The utility of microbiological sampling from macroscopically unremarkable tissue during TKA implantation remains controversial.
To retrospectively evaluate the rate of periprosthetic joint infection (PJI) following TKA after PTOA and to assess the potential benefit of intraoperative microbiological sampling. The secondary objective was to evaluate the presence of prior colonization in osteosynthetic hardware among the affected cases.
A retrospective screening of the hospital database was conducted between 2008 and 2022, including only AO/OTA type 41-B and 41-C fractures. Patients were assigned to a sampling group (with microbiological sampling during TKA) or a control group (without sampling). All patients received structured follow-up to assess postoperative complications.
A total of 40 patients met the screening criteria. In the sampling group ( = 29), 17.24% required surgical revision, and the rate of PJI was 3.45%. In the control group ( = 11), 18.14% underwent revision surgery, with a PJI rate of 9.09%. The average follow-up period was 4.35 years (range 2-11.6 years).
TKA in patients with PTOA is associated with a heightened risk of complications. A noteworthy possible correlation between systematic microbiological sampling and reduced PJI incidence was observed. While the small sample size limits definitive conclusions regarding causality, the findings support the potential value of consistent intraoperative sampling.
胫骨近端骨折可导致创伤后骨关节炎（PTOA），此类患者随后进行全膝关节置换术（TKA）时并发症发生率会升高。推荐采用两阶段方法，即在TKA之前选择性取出内固定器械。在TKA植入过程中从宏观上无异常的组织进行微生物采样的效用仍存在争议。
回顾性评估PTOA后TKA假体周围关节感染（PJI）的发生率，并评估术中微生物采样的潜在益处。次要目的是评估受影响病例中内固定器械先前定植的情况。
对2008年至2022年期间的医院数据库进行回顾性筛查，仅纳入AO/OTA 41 - B型和41 - C型骨折患者。患者被分为采样组（TKA期间进行微生物采样）或对照组（不进行采样）。所有患者均接受结构化随访以评估术后并发症。
共有40例患者符合筛查标准。在采样组（n = 29）中，17.24%需要手术翻修，PJI发生率为3.45%。在对照组（n = 11）中，18.14%接受了翻修手术，PJI发生率为9.09%。平均随访期为4.35年（范围2 - 11.6年）。
PTOA患者进行TKA时并发症风险较高。观察到系统的微生物采样与降低的PJI发生率之间可能存在显著相关性。虽然样本量较小限制了关于因果关系的确切结论，但研究结果支持术中持续采样的潜在价值。
