High Infection Control Rate and Function After Routine One-stage Exchange for Chronically Infected TKA
High Infection Control Rate and Function After Routine One-stage Exchange for Chronically Infected TKA
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DOI：
10.1007/s11999-012-2480-7
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发表时间：
2013-01-01
影响因子：
4.2
通讯作者：
Argenson, Jean-Noel
中科院分区：
文献类型：
--
作者：
Jenny, Jean-Yves;Barbe, Bruno;Argenson, Jean-Noel
许多外科医生认为两阶段交换是治疗TKA后慢性感染的金标准。一期置换是一种控制感染的替代方法，可能提供更好的膝关节功能，但感染控制率和功能水平尚不清楚。我们询问一期交换方案是否会导致感染控制率和膝关节功能与两期交换后相似。我们随访了2004年7月至2007年2月间接受一期换药治疗的47例慢性感染tka患者。我们监测感染复发并获得膝关节学会评分。我们随访患者至少3年或直到死亡或感染复发。47例患者中有3例（6%）在分离出相同病原体的情况下持续或复发了指数感染。3例患者（6%）指数感染得到控制，但在6至17个月期间出现了另一种病原体感染。无感染组3年生存率为87%，指数感染痊愈组3年生存率为91%。45例患者中有25例（56%）膝关节社会评分超过150分。虽然常规一期置换术与较高的感染复发失败率无关，但与既往患者进行两期置换术相比，膝关节功能并未得到改善。对于慢性感染的TKA，一期置换可能是一种合理的替代方法，因为它对患者更方便，没有两次手术和住院的风险，并且降低了成本。理想的单阶段交换候选材料应在今后的研究中加以确定。四级，治疗性研究。有关证据水平的完整描述，请参阅作者说明。
Many surgeons consider two-stage exchange the gold standard for treating chronic infection after TKA. One-stage exchange is an alternative for infection control and might provide better knee function, but the rates of infection control and levels of function are unclear.We asked whether a one-stage exchange protocol would lead to infection control rates and knee function similar to those after two-stage exchange.We followed all 47 patients with chronically infected TKAs treated with one-stage exchange between July 2004 and February 2007. We monitored for recurrence of infection and obtained Knee Society Scores. We followed patients a minimum of 3 years or until death or infection recurrence.Three of the 47 patients (6%) experienced a persistence or recurrence of the index infection with the same pathogen isolated. Three patients (6%) had control of the index infection but between 6 and 17 months experienced an infection with another pathogen. The 3-year survival rates were 87% for being free of any infection and 91% for being healed of the index infection. Twenty-five of the 45 patients (56%) had a Knee Society Score of more than 150 points.While routine one-stage exchange was not associated with a higher rate of infection recurrence failure, knee function was not improved compared to that of historical patients having two-stage exchange. One stage-exchange may be a reasonable alternative in chronically infected TKA as a more convenient approach for patients without the risks of two operations and hospitalizations and for reducing costs. The ideal one stage-exchange candidate should be identified in future studies.Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.