Metal-backed patellar component failure in total knee arthroplasty: a possible risk for late infection.
Metal-backed patellar component failure in total knee arthroplasty: a possible risk for late infection.
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全膝关节置换术中金属支持的髌骨组件失效：晚期感染的可能风险。
DOI：
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
D. Ilstrup
中科院分区：
文献类型：
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作者：
R. S. Petrie;A. Hanssen;D. Osmon;D. Ilstrup
1985年至1987年间，1503例患者植入了1837例原发性全膝关节置换术（TKA）假体。I组843个膝关节采用金属支撑髌骨假体（MBPC）， II组994个膝关节采用全聚乙烯髌骨假体（APPC）。随访时间平均为5.7年（2 - 11年）。MBPC 24例（2.9%），APPC TKA 16例（1.6%）发生深部感染。在关节置换术至2年随访期间，8例MBPC和11例APPC膝关节发生假体周围深度感染。两组在此时间间隔内的累计感染概率差异无统计学意义（相对危险度为0.9；95%可信区间[CI]， 0.3-2.1; P = 0.73）。然而，经过2年的随访，16例MBPC膝关节和5例APPC膝关节发生了晚期感染，在这段时间内，MBPC膝关节和APPC膝关节的累计感染概率差异有统计学意义（相对危险度为3.1;95% CI, 1.1-8.5; P = 0.02）。虽然这些晚期感染风险增加的机制尚不清楚，但在颗粒金属和聚乙烯碎片存在的情况下，随之而来的滑膜炎、积液和膝关节相对充血可能增加细菌播散到这些假体上的可能性。颗粒金属碎片先前已被证明可以抑制细菌吞噬作用，并可能在这些感染的发病机制中发挥作用。我们认为金属支撑髌骨衰竭的存在代表了后期假体感染发展的“假体风险”。
Between 1985 and 1987, 1837 primary total knee arthroplasty (TKA) prostheses were implanted in 1503 patients. Group I included 843 knee with metal-backed patellar components (MBPC), and group II included 994 knees with all polyethylene patellar components (APPC). Follow-up averaged 5.7 years (range, 2 to 11 years). Twenty-four MBPC (2.9%) and 16 APPC TKA cases (1.6%) developed deep infection. In the time interval between arthroplasty and 2-year follow-up, eight MBPC and 11 APPC knees developed deep periprosthetic infection. The difference in the cumulative probability of infection between the two groups during this time interval was not significant (relative risk, 0.9; 95% confidence interval [CI], 0.3-2.1; P = 0.73). However, after the 2-year follow-up, 16 MBPC and 5 APPC knees developed late infection, and the difference in the cumulative probability of infection between the MBPC and APPC knees during this time interval was significant (relative risk, 3.1; 95% CI, 1.1-8.5; P = 0.02). Although the mechanism for this increased risk of these late infections is not well understood, the attendant synovitis, effusion, and relative hyperemia of these knees in the presence of the particulate metal and polyethylene debris may increase the potential of bacterial seeding to these prostheses. Particulate metal debris has been previously shown to suppress bacterial phagocytosis and may play a role in the pathogenesis of these infections. We propose that the presence of metal-backed patellar failure represents a "prosthesis at risk" for the development of late prosthetic infection.