Abstract:
BACKGROUND:Unicompartmental knee arthroplasty restores function and improves pain in appropriately selected patients. Scant evidence exists regarding the treatment of periprosthetic joint infection (PJI) after unicompartmental knee arthroplasty (UKA). QUESTIONS/PURPOSES:(1) What was the overall survivorship free from reinfection? (2) What is the survivorship free of all-cause revision? (3) What are the Knee Society scores (KSS) and complications after surgical treatment of UKA PJI? METHODS:This retrospective study with data drawn from a longitudinally maintained institutional registry identified 15 UKA PJIs between 1992 and 2014. The median age at PJI diagnosis was 58 years (range, 41-82 years), nine of 15 were men, and the median body mass index was 29 kg/m (range, 23-36 kg/m). Ten patients (10 of 15) satisfied major Musculoskeletal Infection Society diagnostic criteria. There were five patients (five of 15) with early postoperative infections, five (five of 15) with acute hematogenous infections, and five (five of 15) with chronic PJIs. Two-stage exchange was performed in four patients with PJIs (four of 15), and débridement, antibiotics, and implant retention (DAIR) was performed in 11 patients (11 of 15) with PJIs. We performed Kaplan-Meier survivorship analysis for reinfection and revision procedures. Thirteen patients had a minimum of 2 years' followup and were included in the clinical analysis. Median followup was 4 years (range, 2-6 years). We calculated KSS. RESULTS:Infection-free survivorship was 71% at 5 years (95% confidence interval [CI], 46%-96%). Treatment success was higher for patients undergoing two-stage exchange (100% at 5 years; 95% CI, 100%-100%) versus DAIR (61% at 5 years; 95% CI, 31%-92%). Four of 11 patients undergoing DAIR had developed a reinfection at final followup. Survivorship free of any revision was 49% at 5 years (95% CI, 19%-79%). One patient from the two-stage exchange cohort underwent femoral component revision for aseptic loosening 5 years after PJI treatment, and two patients from the DAIR group were converted to TKA for disease progression at a mean of 4 years. In patients with a minimum of 2 years' followup, median KSS improved from 73 (range, 50-93) before index UKA to 94 (range, 55-100; p = 0.016). CONCLUSIONS:Treatment of UKA PJI with DAIR was associated with a lower infection-free survivorship at 5 years compared with two-stage exchange with conversion to TKA. Among those patients who were infection-free, a number needed reoperations for disease progression (in the DAIR group) or component loosening (in both groups). UKA PJI results in substantial morbidity, and patients with these infections should be followed closely for aseptic causes of failure in addition to infection recurrence. LEVEL OF EVIDENCE:Level IV, therapeutic study.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Hernandez NM,Petis SM,Hanssen AD,Sierra RJ,Abdel MP,Pagnano MWdoi
10.1097/CORR.0000000000000372subject
Has Abstractpub_date
2019-01-01 00:00:00pages
70-77issue
1eissn
0009-921Xissn
1528-1132pii
00003086-201901000-00015journal_volume
477pub_type
杂志文章abstract::Osteopetrosis is a metabolic bone disease characterized by a systemic increase in skeletal mass. It results from a defect in the production or function of osteoclasts and is inherited in nine genetically distinct osteopetrotic animal mutations and man. Studies of these mutations have revealed that osteopetrosis is a c...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
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abstract::The treatment of the dislocated radial head in a late Monteggia lesion remains a matter of controversy. Annular ligament reconstruction using a strip of triceps tendon is a commonly used technique. Although most published series report good and excellent results, the overall complication rate of this procedure is not ...
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abstract::The causative factors and the clinical course of symptoms related to nerve injury in total hip arthroplasty were evaluated in 34 patients who underwent surgery during the period from 1969 to 1981. The overall incidence of this complication was 0.6%, with an incidence of 1.0% during the first seven years and of 0.3% du...
journal_title:Clinical orthopaedics and related research
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更新日期:1983-10-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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abstract::The mainstay of local control of primary bone malignancies in the skeletally immature has been amputation or, in selected cases, rotationplasty. The development of expandable endoprostheses has permitted an alternative approach for local control in the growing child. Between January 1985 and December 1987, 12 skeletal...
journal_title:Clinical orthopaedics and related research
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pub_type: 杂志文章,多中心研究
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abstract::The effect of chymopapain injection was investigated in myelographically confirmed intervertebral disc herniation in 268 patients after ten years. Mean age is 39.4 years, 178 males and 90 females. Sixty-two patients had compensation or litigation and 12 had prior lumbar spine surgery. Discography was performed in 223 ...
journal_title:Clinical orthopaedics and related research
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更新日期:1986-05-01 00:00:00
abstract::The differentiation of connective tissue outgrowths of adult bone marrow in response to the organic matrix of bone was observed in tissue culture by correlated histologic, electron microscopic, biochemical, and radioisotope-labeling methods. On a substratum of bone matrix gelatin, myelogenous cells degenerate and disa...
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更新日期:1981-01-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:1987-09-01 00:00:00
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更新日期:1989-02-01 00:00:00
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更新日期:2003-05-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:1987-06-01 00:00:00
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更新日期:1990-03-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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更新日期:1989-03-01 00:00:00
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