■假体关节感染(PJI)是全膝关节置换术(TKA)后的破坏性并发症;金标准手术方法包括两个阶段,修订TKA(TSR)。由于较新的,关于这个问题的新证据,已经逐步转向单阶段修订方法(SSR),有了减轻患者发病率的所谓好处,减少并发症,降低成本。然而,关于两种方法在慢性PJI中的安全性和结果的证据仍然存在大量空白。本研究旨在全面回顾有关SSR的文献;并评估其在PJI后修订TKA中的作用。
■叙述性审查涉及对数据库的全面搜索(Embase,MedlineandPubmed),于2024年1月20日使用特定关键词进行。所有讨论在TKA后使用SSR管理PJI的手稿都被考虑用于审查。在筛选的手稿中,意见文章,给编辑的信件和非英文手稿被排除在外。
■文献检索共232项研究。在对这些手稿进行了详细的审查之后,最终入选26篇。据报道,SSR后的总体成功率为73%至100%(与TSR相当)。在经细菌学证实的感染的PJI患者中进行SSR,足够的软组织覆盖,免疫能力强的宿主和对抗生素的优异耐受性。SSR和TSR之间的主要区别在于2个阶段之间的间隔仅为几分钟而不是6周。适当的局部,术中抗生素治疗,为了确定良好的结局,需要充分的术后全身抗生素覆盖.SSR优于TSR的一些主要好处包括降低发病率,减少并发症(如关节纤维化或麻醉相关不良事件),改善四肢功能,早些时候恢复活动,减轻机械(假体相关)并发症和提高患者满意度。
■SSR是治疗慢性PJI的可靠方法。根据我们对文献的全面回顾,可以得出结论,正确选择患者,广泛清创术,复杂的重建战略,病原生物的鉴定,开始适当的抗生素治疗和确保充分的随访是成功结局的关键决定因素.要实现这一目标,无疑需要在个案基础上采取MDT方法。
UNASSIGNED: Prosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA); and the gold standard surgical approach involves a two-staged, revision TKA (TSR). Owing to the newer, emerging evidence on this subject, there has been gradual shift towards a single-stage revision approach (SSR), with the purported benefits of mitigated patient morbidity, decreased complications and reduced costs. However, there is still substantial lacuna in the evidence regarding the safety and outcome of the two approaches in chronic PJI. This study aimed to comprehensively review of the literature on SSR; and evaluate its role within Revision TKA post PJI.
UNASSIGNED: The narrative review involved a comprehensive search of the databases (Embase, Medline and Pubmed), conducted on 20th of January 2024 using specific key words. All the manuscripts discussing the use of SSR for the management of PJI after TKA were considered for the review. Among the screened manuscripts, opinion articles, letters to the editor and non-English manuscripts were excluded.
UNASSIGNED: The literature search yielded a total 232 studies. Following a detailed scrutiny of these manuscripts, 26 articles were finally selected. The overall success rate following SSR is reported to range from 73 % to 100 % (and is comparable to TSR). SSR is performed in PJI patients with bacteriologically-proven infection, adequate soft tissue cover, immuno-competent host and excellent tolerance to antibiotics. The main difference between SSR and TSR is that the interval between the 2 stages is only a few minutes instead of 6 weeks. Appropriate topical, intraoperative antibiotic therapy, followed by adequate postoperative systemic antibiotic cover are necessary to ascertain good outcome. Some of the major benefits of SSR over TSR include reduced morbidity, decreased complications (such as arthrofibrosis or anesthesia-associated adverse events), meliorated extremity function, earlier return to activities, mitigated mechanical (prosthesis-associated) complications and enhanced patient satisfaction.
UNASSIGNED: SSR is a reliable approach for the management of chronic PJI. Based on our comprehensive review of the literature, it may be concluded that the right selection of patients, extensive debridement, sophisticated reconstruction strategy, identification of the pathogenic organism, initiation of appropriate antibiotic therapy and ensuring adequate follow-up are the key determinants of successful outcome. To achieve this will undoubtedly require an MDT approach to be taken on a case-by-case basis.