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Abstract：
Infections are rare and poorly studied complications of unicompartmental knee arthroplasty (UKA) surgery. They are significantly less common compared to infections after total knee arthroplasties (TKAs). Optimal management of periprosthetic joint infections (PJIs) after a UKA is not clearly defined in the literature. This article presents the results of the largest multicentre clinical study of UKA PJIs treated with Debridement, Antibiotics and Implant Retention (DAIR).
In this retrospective case series, patients presenting between January 2016 and December 2019 with early UKA infection were identified at three specialist centres using the Musculoskeletal Infection Society (MSIS) criteria. All patients underwent a standardized treatment protocol consisting of the DAIR procedure and antibiotic therapy comprising two weeks of intravenous (IV) antibiotics followed by six weeks of oral therapy. The main outcome measure was overall survivorship free from reoperation for infection.
A total of 3225 UKAs (2793 (86.2%) medial and 432 (13.8%) lateral UKAs) were performed between January 2016 and December 2019. Nineteen patients had early infections necessitating DAIR. The mean follow-up period was 32.5 months. DAIR showed an overall survivorship free from septic reoperation of 84.2%, with overall survivorship free from all-cause reoperation of 78.95%.The most common bacteria were Coagulase-negative Staphylococci, Staphylococcus aureus and Group B Streptococci. Three patients required a second DAIR procedure but remained free from re-infection at follow-up obviating the need for more demanding, staged revision surgery.
In infected UKAs, the DAIR procedure produces a high rate of success, with a high survivorship of the implant.Key messagesDebridement, Antibiotics and Implant Retention (DAIR) is a successful and minimally invasive surgical option for the management of periprosthetic joint infections (PJIs) after UKA.The surface area available for bacteria to colonise is much smaller in UKAs compared to total knee arthroplasties (TKAs), and this may account for the higher success rates of the DAIR procedure in infected UKAs versus infected TKAs.A second DAIR procedure can be considered in the management of the early recurrence of PJIs with a well-fixed UKA.
In this retrospective case series, patients presenting between January 2016 and December 2019 with early UKA infection were identified at three specialist centres using the Musculoskeletal Infection Society (MSIS) criteria. All patients underwent a standardized treatment protocol consisting of the DAIR procedure and antibiotic therapy comprising two weeks of intravenous (IV) antibiotics followed by six weeks of oral therapy. The main outcome measure was overall survivorship free from reoperation for infection.
A total of 3225 UKAs (2793 (86.2%) medial and 432 (13.8%) lateral UKAs) were performed between January 2016 and December 2019. Nineteen patients had early infections necessitating DAIR. The mean follow-up period was 32.5 months. DAIR showed an overall survivorship free from septic reoperation of 84.2%, with overall survivorship free from all-cause reoperation of 78.95%.The most common bacteria were Coagulase-negative Staphylococci, Staphylococcus aureus and Group B Streptococci. Three patients required a second DAIR procedure but remained free from re-infection at follow-up obviating the need for more demanding, staged revision surgery.
In infected UKAs, the DAIR procedure produces a high rate of success, with a high survivorship of the implant.Key messagesDebridement, Antibiotics and Implant Retention (DAIR) is a successful and minimally invasive surgical option for the management of periprosthetic joint infections (PJIs) after UKA.The surface area available for bacteria to colonise is much smaller in UKAs compared to total knee arthroplasties (TKAs), and this may account for the higher success rates of the DAIR procedure in infected UKAs versus infected TKAs.A second DAIR procedure can be considered in the management of the early recurrence of PJIs with a well-fixed UKA.
摘要：
■感染是罕见的，并且对单室膝关节置换术（UKA）手术的并发症研究不足。与全膝关节置换术（TKAs）后的感染相比，它们明显不那么常见。文献中没有明确定义UKA后假体周围感染（PJIs）的最佳管理。本文介绍了使用清创术治疗的UKAPJIs的最大多中心临床研究的结果，抗生素和植入物保留(DAIR)。
■在这个回顾性病例系列中，2016年1月至2019年12月期间出现早期UKA感染的患者在3个专科中心使用肌肉骨骼感染协会(MSIS)标准进行鉴定.所有患者均接受由DAIR程序和抗生素治疗组成的标准化治疗方案，包括两周的静脉内（IV）抗生素，然后是六周的口服治疗。主要结果指标是总体生存率，没有因感染而再次手术。
■在2016年1月至2019年12月期间，共进行了3225个UKAs（2793个（86.2%）内侧和432个（13.8%）外侧UKAs）。19例患者早期感染需要DAIR。平均随访时间为32.5个月。DAIR显示总生存率为84.2%，无败血症再次手术。全因再手术总生存率为78.95%。最常见的细菌是凝固酶阴性葡萄球菌，金黄色葡萄球菌和B组链球菌。三名患者需要进行第二次DAIR手术，但在随访时仍然没有再次感染，从而避免了对更高要求的需要。分期翻修手术。
■在受感染的UKAs中，DAIR程序产生了很高的成功率，植入物的存活率很高。关键信息清创，抗生素和植入物保留（DAIR）是UKA术后治疗假体周围感染（PJIs）的一种成功且微创的手术选择。与全膝关节置换术（TKAs）相比，UKAs中可用于细菌定殖的表面积要小得多，这可能是受感染的UKAs与受感染的TKAs中DAIR程序成功率较高的原因。在使用固定良好的UKA治疗PJIs的早期复发时，可以考虑采用第二种DAIR程序。
■在这个回顾性病例系列中，2016年1月至2019年12月期间出现早期UKA感染的患者在3个专科中心使用肌肉骨骼感染协会(MSIS)标准进行鉴定.所有患者均接受由DAIR程序和抗生素治疗组成的标准化治疗方案，包括两周的静脉内（IV）抗生素，然后是六周的口服治疗。主要结果指标是总体生存率，没有因感染而再次手术。
■在2016年1月至2019年12月期间，共进行了3225个UKAs（2793个（86.2%）内侧和432个（13.8%）外侧UKAs）。19例患者早期感染需要DAIR。平均随访时间为32.5个月。DAIR显示总生存率为84.2%，无败血症再次手术。全因再手术总生存率为78.95%。最常见的细菌是凝固酶阴性葡萄球菌，金黄色葡萄球菌和B组链球菌。三名患者需要进行第二次DAIR手术，但在随访时仍然没有再次感染，从而避免了对更高要求的需要。分期翻修手术。
■在受感染的UKAs中，DAIR程序产生了很高的成功率，植入物的存活率很高。关键信息清创，抗生素和植入物保留（DAIR）是UKA术后治疗假体周围感染（PJIs）的一种成功且微创的手术选择。与全膝关节置换术（TKAs）相比，UKAs中可用于细菌定殖的表面积要小得多，这可能是受感染的UKAs与受感染的TKAs中DAIR程序成功率较高的原因。在使用固定良好的UKA治疗PJIs的早期复发时，可以考虑采用第二种DAIR程序。
