The Insall Award paper - Infection in total knee replacement - A retrospective review of 6489 total knee replacements
The Insall Award paper - Infection in total knee replacement - A retrospective review of 6489 total knee replacements
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DOI：
10.1097/00003086-200111000-00003
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发表时间：
2001-11-01
影响因子：
4.2
通讯作者：
Peterson, M
中科院分区：
文献类型：
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作者：
Peersman, G;Laskin, R;Peterson, M
在1993年至1999年期间，作者所在的机构对6120名患者进行了6489例膝关节置换术。手术是在一个有垂直层流的手术室里进行的，手术团队使用身体排气服。在这些膝关节置换术中，116例膝关节感染，113例可接受随访。100例感染发生在接受初次膝关节置换术的患者中，而其余感染发生在接受膝关节翻修术的患者中。这些膝关节中有97例（86%）发生了假体周围深部感染，其余16例膝关节发生了浅表伤口感染。三分之一的深部感染发生在手术后的前3个月内，其余2/3发生在3个月后。接受初次膝关节置换术患者的总体早期深部感染率为0.39%，而接受翻修膝关节置换术患者的发生率为0.97%。一组在性别、年龄和手术月数方面相匹配的非感染膝关节置换患者作为对照组。在感染风险增加方面具有统计学显著性的合并症包括既往开放性外科手术、免疫抑制治疗、营养不良、低钾血症、糖尿病、肥胖和吸烟史。接受翻修手术的患者的感染风险在统计学上高于接受初次手术的患者。如果手术时间超过2.5小时，感染的风险会显著增加。当围手术期抗生素预防从术后48小时减少到24小时时，感染率没有变化。主要感染性微生物为革兰氏阳性菌（金黄色葡萄球菌、表皮葡萄球菌和B族链球菌）。临床上感染的膝盖中有20%没有可识别的微生物。在每种情况下，患者在获得关节培养之前都在另一家机构接受了抗生素经验性治疗。
Six thousand four hundred eighty-nine knee replacements were done in 6120 patients at the authors' institution between 1993 and 1999. Operations were done in a theater with vertical laminar How and with the surgical team using body exhaust suits. Of these knee replacements, 116 knees became infected and 113 were available for followup. One hundred of the infections occurred in patients undergoing primary knee replacement, whereas the remaining infections occurred in patients undergoing revision knee replacement. Ninety-seven of these knees (86%) had deep periprosthetic infections and the remaining 16 knees had superficial wound infections. One third of the deep infections occurred within the first 3 months after surgery and the remaining 2/3 occurred after 3 months. The overall early deep infection rate for patients undergoing a primary knee replacement was 0.39%, whereas the rate for patients undergoing a revision knee replacement was 0.97%. A cohort of noninfected knee replacements from patients matched for gender, age, and month of surgery was used as a control group. Those comorbidities that were statistically significant in increasing the risk of infection were prior open surgical procedures, immunosuppressive therapy, poor nutrition, hypokalemia, diabetes mellitus, obesity, and a history of smoking. Patients undergoing revision procedures had a statistically higher risk of infection than did patients undergoing primary surgeries. If the surgery took longer than 2.5 hours, the risk of infection was increased significantly. There was no change in the infection rate when the perioperative antibiotic prophylaxis was decreased from 48 to 24 hours after surgery. The predominant infectious organisms were gram-positive (Staphylococcus aureus, Staphylococcus; epidermidis, and Streptococcus Group B). Twenty percent of the knees that were infected clinically had no organisms that could be identified. In each case, the patient had been treated empirically at another institution with antibiotics before a culture of the joint was obtained.