背景:假体周围感染(PJI)是全膝关节置换术(TKA)的破坏性并发症,通常采用两阶段翻修术治疗。我们回顾性评估了与不进行髌骨组件置换的间隔物相比,用关节一期间隔物置换髌骨组件是否与改善预后相关。
方法:来自一个学术机构的139名患者被确定为接受了关节式一期翻修TKA,并进行了至少1年的随访。在139名患者中,91例髌骨组件切除,无需更换,而48人在一期翻修时替换了髌骨组件。记录第一阶段后任何时间的髌骨骨折和再感染。膝盖运动范围(ROM),髌骨厚度,横向倾斜,并在第一阶段后六周测量侧向位移。卡方,费希尔的精确,采用t检验进行比较。组间没有显著的人口统计学差异。
结果:一期翻修时髌骨组件置换与髌骨骨折减少相关(2.1对12.1%,P=0.046),髌骨外侧位移较小(1.7对16.0毫米,P<0.01),并在第一阶段后六周改善了术后前的膝关节ROM(+5.9对-11.4°,P=0.03)。对于替换或未替换的髌骨组,第二阶段翻修后的再感染没有差异(15.4对15%,P=1.000)。虽然第一阶段和第二阶段之间的平均时间没有差异(5.2和4.5个月,P=0.50),在一年的随访中,髌骨成分置换组中更多的患者满意并拒绝第二阶段翻修(45.8%对3.3%,P<0.001)。
结论:在一期翻修时替换髌骨成分与髌骨骨折和髌骨外侧半脱位的发生率降低有关,改进的ROM,并可能提高患者满意度,这些患者中有近一半选择保留垫片。队列之间的再感染率没有差异。
BACKGROUND: Periprosthetic joint infection is a devastating complication of total knee arthroplasty and is often treated with 2-stage revision. We retrospectively assessed whether replacing the patellar component with articulating stage-one spacers was associated with improved outcomes compared to spacers without patellar component replacement.
METHODS: A total of 139 patients from a single academic institution were identified who underwent an articulating stage-one revision total knee arthroplasty and had at least 1-year follow-up. Of the 139 patients, 91 underwent patellar component removal without replacement, while 48 had a patellar component replaced at stage-one revision. Patellar fracture and reinfection at any point after stage-one were recorded. Knee range of motion (ROM), patellar thickness, lateral tilt, and lateral displacement were measured at 6-weeks post stage-one. Chi-square, Fisher\'s exact, and t-tests were utilized for comparisons. There were no significant demographic differences between groups.
RESULTS: Patellar component replacement at stage-one revision was associated with fewer patellar fractures (2.1 versus 12.1%, P = .046), less lateral patellar displacement (1.7 versus 16.0 mm, P < .01), and improved pre to postoperative knee ROM 6 weeks after stage-one (+5.9 versus -11.4°, P = .03). There was no difference in reinfections after stage-2 revision for the replaced or unreplaced patellar groups (15.4 versus 15%, P = 1.000). While the mean time between stage-one and stage-2 was not different (5.2 versus 4.5 months, P = .50), at one-year follow-up, significantly more patients in the patellar component replacement group were satisfied and refused stage-2 revision (45.8 versus 3.3%, P < .001).
CONCLUSIONS: Replacing the patellar component at stage-one revision is associated with a decreased rate of patellar fracture and lateral patellar subluxation, improved ROM, and possible increased patient satisfaction, as reflected by nearly half of these patients electing to keep their spacer. There was no difference in reinfection rates between the cohorts.