Hirakawa K, Stulberg B N, Wilde A H, Bauer T W, Secic M
Cleveland Center for Joint Reconstruction, Ohio 44115, USA.
J Arthroplasty. 1998 Jan;13(1):22-8. doi: 10.1016/s0883-5403(98)90071-7.
Optimum treatment of the infected total knee arthroplasty has not been clearly established. To clarify the efficacy of two-stage reimplantation, experience with 66 infected total knee arthroplasties in 64 patients who had been treated with 2-stage reimplantation total knee arthroplasty between September 1980 and October 1993 was reviewed. Of these, 55 knees in 54 patients were available for follow-up examinations at an average of 61.9 months (range, 28-146 months). The initial diagnoses were rheumatoid arthritis (14 knees) and osteoarthritis (41 knees). Reimplantation was successful in 80.0% of knees with low-virulence organisms (coagulase-negative Staphylococcus, Streptococcus), 71.4% with polymicrobial organisms, and 66.7% with high-virulence organisms (methicillin-resistant Staphylococcus aureus). Reimplantation was successful in 82% of patients with osteoarthritis and in 54% of patients with rheumatoid arthritis (P = .024). The success rate was 92% if infection occurred after primary arthroplasty but only 41% if after multiple previous knee operations (arthroscopy, osteotomy, or revision total knee arthroplasty) (P < .001).
感染性全膝关节置换术的最佳治疗方法尚未明确确立。为阐明两阶段再植入的疗效，回顾了1980年9月至1993年10月期间64例接受两阶段再植入全膝关节置换术治疗的66例感染性全膝关节置换术的经验。其中，54例患者的55个膝关节可进行平均61.9个月（范围28-146个月）的随访检查。初始诊断为类风湿性关节炎（14个膝关节）和骨关节炎（41个膝关节）。低毒力微生物（凝固酶阴性葡萄球菌、链球菌）感染的膝关节再植入成功率为80.0%，多种微生物感染的为71.4%，高毒力微生物（耐甲氧西林金黄色葡萄球菌）感染的为66.7%。骨关节炎患者再植入成功率为82%，类风湿性关节炎患者为54%（P = 0.024）。如果感染发生在初次关节置换术后，成功率为92%，但如果发生在多次先前膝关节手术（关节镜检查、截骨术或翻修全膝关节置换术）之后，成功率仅为41%（P < 0.001）。
