Infection after total knee arthroplasty - A retrospective study of the treatment of eighty-one infections
Infection after total knee arthroplasty - A retrospective study of the treatment of eighty-one infections
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DOI：
10.2106/00004623-199910000-00008
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发表时间：
1999-10-01
影响因子：
5.3
通讯作者：
Gustilo, RB
中科院分区：
文献类型：
--
作者：
Segawa, H;Tsukayama, DT;Gustilo, RB
背景资料：全膝关节置换术部位感染的临床表现可作为治疗指南，包括决定是否保留或取出假体。我们回顾了全膝关节置换术后感染的治疗结果，以评估基于感染临床背景的四种治疗方案的有效性。方法：我们回顾性评价了70个国家81例感染的治疗结果，连续6名患者，他们要么在全膝关节置换术后发生感染，要么在手术期间获得的假体周围组织标本的术中培养多次阳性，由于假定的无菌性松动进行了全膝关节置换翻修术。根据四种方案之一对患者进行管理。5例术中培养阳性患者的5例感染仅接受抗生素治疗。21例患者的23例术后早期感染接受了清创、抗生素治疗和假体保留治疗。28例患者中的29例晚期慢性感染在抗生素疗程后接受了延迟置换关节成形术。6例患者的7例急性血源性感染接受了清创、抗生素治疗和假体保留治疗。17例患者中的17例感染没有按照四种方案之一进行治疗。16例晚期慢性感染采用关节固定术（5例感染）或清创术、抗生素治疗和假体保留（11例感染）进行治疗。一个急性血源性感染治疗切除关节成形术，因为危及生命的败血症。结果：平均随访时间为4.0年（范围，0.3至14.0年）。11名接受关节融合术、关节切除术或随访不到两年的膝上截肢术的患者作为治疗失败的个体纳入研究。在根据方案管理的患者组中，所有5例基于阳性术中培养诊断的感染、10例深部早期感染中的5例、所有13例浅表早期感染、29例晚期慢性感染中的24例和7例急性血源性感染中的5例的初始疗程均获得成功。只有一个11假体的患者有一个晚期慢性感染，没有按照协议治疗成功保留后清创术。结论：我们的治疗方案，这是基于感染的临床环境，是成功的大多数患者。与治疗失败相关的主要因素是免疫状态受损。骨丢失和关节周围软组织坏死也使这些感染的治疗复杂化。
Background: The clinical presentation of an infection at the site of a total knee arthroplasty can be used as a guide to treatment, including the decision as to whether the prosthesis should be retained or removed. We reviewed the results of treatment of infection after total knee arthroplasty to evaluate the effectiveness of four treatment protocols based on the clinical setting of the infection.Methods: We retrospectively evaluated the results of treatment of eighty-one infections in seventy-six consecutive patients who either had an infection after a total knee arthroplasty or had multiple positive intraoperative cultures of specimens of periprosthetic tissue obtained during a revision total knee arthroplasty performed because of presumed aseptic loosening. The patients were managed according to one of four protocols. Five infections in five patients who had positive intraoperative cultures were treated with antibiotic therapy alone. Twenty-three early postoperative infections in twenty-one patients were treated with debridement, antibiotic therapy, and retention of the prosthesis. Twenty-nine late chronic infections in twenty-eight patients were treated with a delayed-exchange arthroplasty after a course of antibiotics. Seven acute hematogenous infections in six patients were treated with debridement, antibiotic therapy, and retention of the prosthesis. Seventeen infections in seventeen patients mere not treated according to one of the four protocols. Sixteen late chronic infections were treated either with an arthrodesis (five infections) or with debridement, antibiotic therapy, and retention of the prosthesis (eleven infections). One acute hematogenous infection was treated with resection arthroplasty because of life-threatening sepsis.Results: The mean duration of follow-up was 4.0 years (range, 0.3 to 14.0 years). Eleven patients who had an arthrodesis, a resection arthroplasty; or an above-the-knee amputation after less than two years of follow-up were included in the study as individuals who had a failure of treatment. In the group of patients who were managed according to protocol, the initial course of treatment was successful for all five infections that were diagnosed on the basis of positive intraoperative cultures, five of the ten deep early infections, all thirteen superficial early infections, twenty-four of the twenty-nine late chronic infections, and five of the seven acute hematogenous infections. Only one of eleven prostheses in patients who had a late chronic infection that was not treated according to protocol was successfully retained after debridement.Conclusions: Our treatment protocols, which were based on the clinical setting of the infection, were successful for most patients. A major factor associated,vith treatment failure was a compromised immune status. Bone loss and necrosis of the soft tissues around the joint also complicated the treatment of these infections.