目的:探讨全膝关节置换术(TKA)后假体周围感染(PJI)1.5期置换置换的无菌存活情况。
方法:回顾性分析88例无再感染的PJI1.5期置换置换手术。使用抗生素混合水泥植入高压灭菌的股骨组件和新的聚乙烯插入物(PE)。未重新插入移植的胫骨组件。术前和最后一次随访(最后一次原位植入物)时,对西安大略省和麦克马斯特大学的骨关节炎指数和活动范围进行了临床评估。射线照相,术前测量髋-膝-踝角度(HKA)和组件位置,术后(1.5期关节置换术后1个月),在最后的后续行动中。生存率用Kaplan-Meier方法分析,其中失败被定义为由于无菌失败而再次手术。分析了平均故障时间和故障部位。从人口统计学和术后HKA(HKA>0±3°)和组件位置(α角>95±3°,β角>90±3°,γ角>3±3°,δ角>87±3°)。
结果:间隔物原位时间为3.7年(0.2-6.4)。临床结果在末次随访时显著改善了髋-膝-踝。射线照相,术后HKA平均为外翻0.1°。平均α,β,γ,术后组件位置的δ角为95.9°,90.4°,3.8°,和86.7°,分别。1-,2-,术后5年生存率为90.9%,86.4%,80.6%,分别。平均失败期为2.0年(0.2-5.3)。无菌性松动18例(20.8%),发生在1个膝盖的股骨和胫骨两侧,只有17个膝盖的胫骨侧。PE的冠状位置不合适(β角>90±3°)是影响生存的重要因素(比值比=5.491;p=0.011)。
结论:当使用高压灭菌的股骨组件和新PE时,1.5期置换关节成形术的无菌存活率是可以接受的。PE的适当冠状位置有助于确保1.5期交换关节成形术的有利存活。
方法:IV.
OBJECTIVE: To investigate the aseptic survival of 1.5-stage exchange arthroplasty for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA).
METHODS: Eighty-eight cases of 1.5-stage exchange arthroplasty for PJI without reinfection were retrospectively analysed. The autoclaved femoral component and new polyethylene insert (PE) were implanted using antibiotic mixed cement. The explanted tibial component was not reinserted. The Western Ontario and McMaster Universities Osteoarthritis Index and range of motion were clinically evaluated preoperatively and at the last follow-up (the last time for the implant in situ). Radiographically, hip-knee-ankle angle (HKA) and component positions were measured preoperatively, postoperatively (1 month after the 1.5-stage exchange arthroplasty), and at the last follow-up. The survival rate was analysed using the Kaplan-Meier method, in which failure was defined as reoperation due to aseptic failure. Mean period to failure and failure site were analysed. Factors affecting survival were investigated in terms of demographics and inappropriateness of the postoperative HKA (HKA > 0 ± 3°) and component positions (α angle > 95 ± 3°, β angle > 90 ± 3°, γ angle > 3 ± 3°, and δ angle > 87 ± 3°).
RESULTS: The spacer in-situ time was 3.7 years (0.2-6.4). The clinical results improved hip-knee-ankle significantly at the last follow-up. Radiographically, the average HKA was valgus 0.1° postoperatively. The average α, β, γ, and δ angles of the postoperative component positions were 95.9°, 90.4°, 3.8°, and 86.7°, respectively. The 1-, 2-, and 5-year postoperative survival rates were 90.9%, 86.4%, and 80.6%, respectively. The mean period to failure was 2.0 years (0.2-5.3). There were 18 cases of aseptic loosening (20.8%), occurring on both the femur and tibial sides in 1 knee, and only on the tibial side in 17 knees. Inappropriate coronal position of the PE (β angle > 90 ± 3°) was a significant factor affecting survival (odds ratio = 5.491; p = 0.011).
CONCLUSIONS: The aseptic survival of the 1.5-stage exchange arthroplasty was acceptable when using an autoclaved femoral component and new PE. The appropriate coronal position of the PE helps ensure favourable survival of 1.5-stage exchange arthroplasty.
METHODS: IV.