Two-Stage Total Knee Arthroplasty for Prosthetic Joint Infection
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: This retrospective review was conducted to identify prognostic factors for two-stage reimplantation for infected total knee arthroplasty (TKA) and the rate of reinfection following revision TKA. Materials and Methods: Out of 88 patients diagnosed with post-TKA infection between 1998 and 2011, 76 underwent two-stage reimplantation and were reviewed in this study. The 76 patients were divided into two groups—those who experienced reinfection and those who did not. Comorbidities, culture results, and inflammation indices were analyzed and compared between the two groups.Results: Of the 76 patients who underwent a two-stage reimplantation, 18 (23.7%) experienced reinfection. Patients with more than three comorbidities had significantly higher reinfection rates than those with less than three comorbidities (47.1% vs. 4.8%, p=0.032). The reinfection rate between the culture positive prosthetic joint infection group and the culture negative prosthetic joint infection group was not significantly different (p=0.056). Inflammation indices (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) showed a statistically significant difference between patients with reinfection and those without reinfection at 4 weeks after the first-stage surgery.Conclusions: Reimplantation must be carefully performed when the risk of reinfection is high, particularly in patients with more than three systemic or local comorbidities and higher inflammation indices (ESR and CRP) prior to revision TKA.
Abstract
Purpose: This retrospective review was conducted to identify prognostic factors for two-stage reimplantation for infected total knee arthroplasty (TKA) and the rate of reinfection following revision TKA. Materials and Methods: Out of 88 patients diagnosed with post-TKA infection between 1998 and 2011, 76 underwent two-stage reimplantation and were reviewed in this study. The 76 patients were divided into two groups—those who experienced reinfection and those who did not. Comorbidities, culture results, and inflammation indices were analyzed and compared between the two groups.Results: Of the 76 patients who underwent a two-stage reimplantation, 18 (23.7%) experienced reinfection. Patients with more than three comorbidities had significantly higher reinfection rates than those with less than three comorbidities (47.1% vs. 4.8%, p=0.032). The reinfection rate between the culture positive prosthetic joint infection group and the culture negative prosthetic joint infection group was not significantly different (p=0.056). Inflammation indices (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) showed a statistically significant difference between patients with reinfection and those without reinfection at 4 weeks after the first-stage surgery.Conclusions: Reimplantation must be carefully performed when the risk of reinfection is high, particularly in patients with more than three systemic or local comorbidities and higher inflammation indices (ESR and CRP) prior to revision TKA.
참고문헌 (29)
- Osmon DR, "Infectious Diseases Society of America. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America", Clin Infect Dis, 56, pp.e1~e25 (2013)
- Zimmerli W, "Prosthetic-joint infections", N Engl J Med, 351, pp.1645~1654 (2004)
- Darouiche RO, "Treatment of infections associated with surgical implants", N Engl J Med, 350, pp.1422~1429 (2004)
- Sia IG, "Prosthetic joint infections", Infect Dis Clin North Am, 19, pp.885~914 (2005)
- Kurd MF, "Two-stage exchange knee arthroplasty: does resistance of the infecting organism influence the outcome?", Clin Orthop Relat Res, 468, pp.2060~2066 (2010)
- Goldman RT, "2-stage reimplantation for infected total knee replacement", Clin Orthop Relat Res, (331), pp.118~124 (1996)
- Haleem AA, "Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty", Clin Orthop Relat Res, (428), pp.35~39 (2004)
- McLaren AC, "Salvage of infected total knee components", Clin Orthop Relat Res, (331), pp.146~150 (1996)
- Mittal Y, "Two-stage reimplantation for periprosthetic knee infection involving resistant organisms", J Bone Joint Surg Am, 89, pp.1227~1231 (2007)
- Hirakawa K, "Results of 2-stage reimplantation for infected total knee arthroplasty", J Arthroplasty, 13, pp.22~28 (1998)
- Jamsen E, "Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis", J Bone Joint Surg Am, 94, pp.e101~ (2012)
- Cierny G 3rd, "Periprosthetic total joint infections: staging, treatment, and outcomes", Clin Orthop Relat Res, (403), pp.23~28 (2002)
- Kubista B, "Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty", Int Orthop, 36, pp.65~71 (2012)
- Tigani D, "Two-stage reimplantation for periprosthetic knee infection : Influence of host health status and infecting microorganism", Knee, 20, pp.9~18 (2013)
- Mortazavi SM, "Failure following revision total knee arthroplasty : infection is the major cause", Int Orthop, 35, pp.1157~1164 (2011)
- Parvizi J, "Periprosthetic infection due to resistant staphylococci : serious problems on the horizon", Clin Orthop Relat Res, 467, pp.1732~1739 (2009)
- Berbari EF, "Culture-negative prosthetic joint infection", Clin Infect Dis, 45, pp.1113~1119 (2007)
- Choi HR, "Periprosthetic joint infection with negative culture results : clinical characteristics and treatment outcome", J Arthroplasty, 28, pp.899~903 (2013)
- Windsor RE, "Two-stage reimplantation for the salvage of total knee arthroplasty complicated by infection : further follow-up and refinement of indications", J Bone Joint Surg Am, 72, pp.272~278 (1990)
- Levitsky KA, "Evaluation of the painful prosthetic joint. Relative value of bone scan, sedimentation rate, and joint aspiration", J Arthroplasty, 6, pp.237~244 (1991)
- Puhto AP, "Two-stage revision for prosthetic joint infection : out come and role of reimplantation microbiology in 107 cases", J Arthroplasty, 29, pp.1101~1104 (2014)
- Antonio Silvestre, "Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer", Clinics in Orthopedic Surgery, 5(3), pp.180~187 (2013), 대한정형외과학회
- Bejon P, "Two-stage revision for prosthetic joint infection : predictors of outcome and the role of reimplantation microbiology", J Antimicrob Chemother, 65, pp.569~575 (2010)
- Hozack WJ, "New definition for periprosthetic joint infection", J Arthroplasty, 26, pp.1135~ (2011)
- Marculescu CE, "Outcome of prosthetic joint infections treated with debridement and retention of components", Clin Infect Dis, 42, pp.471~478 (2006)
- Ewald FC, "The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system", Clin Orthop Relat Res, (248), pp.9~12 (1989)
- Moran E, "Guiding empirical antibiotic therapy in orthopaedics : The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention", J Infect, 55, pp.1~7 (2007)
- Marschall J, "Current management of prosthetic joint infections in adults : results of an Emerging Infections Network survey", Int J Antimicrob Agents, 41, pp.272~277 (2013)
- 전근철, "Infection Following Total Knee Arthroplasty", Knee Surgery and Related Research, 25(3), pp.93~99 (2013), 대한슬관절학회