膝关节单髁置换术后假体周围感染的临床诊治进展

Progress in clinical diagnosis and treatment of periprosthetic joint infection after UKA

单间室膝关节置换术(unicompartmental knee arthroplasty,UKA)是一种治疗晚期膝关节单间室骨关节炎(knee osteoarthritis,KOA)的有效方法。在严格适应证下,UKA可取得良好的长期随访结果。Mohammad等[1]报道8658例牛津三代UKA,术后患者长期的随访结果,其假体留存率10年为93%,15年为89%。Pandit等[2]对1000例UKA患者进行长达15年随访,假体留存率10年为94%,15年为91%。与全膝关节置换术(total knee arthroplasty,TKA)一样.

Periprosthetic joint infection(PJI)is one of the serious complications after the unicompartment knee arthroplasty(UKA).We will review the epidemiology,diagnosis,treatment and prevention of PJI after UKA to provide references.Domestic and foreign literature about PJI after UKA was reviewed and summarized.There were relatively less reports on PJI after UKA.Its incidence ranged from 0.2%to 1%,lower than that after TKA.There was still no consensus on the diagnosis and management of PJI after UKA,and limited diagnostic criteria were included in the International Consensus Meeting(ICM)of PJI.Considering that UKA did not replace the normal osteochondral and ligament structure of the compartment,additional questions were raised about the diagnosis and treatment of PJI after UKA.Laboratory indicators for diagnosis had slightly different thresholds.According to ICM,PJI after UKA was divided into acute,chronic and acute haematogenous infections.Treatment can be determined by classification:onestage or two-stage revision for chronic PJI;debridement antibiotics irrigation and retention(DAIR)for acute PJI.Structural bone graft,metal augment,or prosthesis with a long extension stem were usually required when TKA was applied.PJI after UKA can be prevented by preoperative,intraoperative and postoperative measures.Infection is not a common complication after UKA,and its incidence is lower than that of TKA.There is no consensus on the diagnosis and management of PJI after UKA,so that it can be guided according to standards of TKA infection.Perioperative management is the key to avoid postoperative PJI.