性别对改良全膝关节置换术后无菌性松动及PJI复发的影响

Q4 Medicine Clinical Osteology Pub Date : 2021-05-17 DOI:10.3390/OSTEOLOGY1020010
A. Kienzle, S. Walter, Y. Palmowski, S. Kirschbaum, Lara Biedermann, P. von Roth, C. Perka, Michael Müller
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引用次数: 5

摘要

背景:假体周围关节感染(PJI)是全膝关节置换术(TKA)后常见但严重的并发症。手术干预和抗生素治疗是必要的,以达到成功,无感染的结果。与初次TKA后的结果相比,pji依赖性翻修手术后假体失败率急剧增加。复发性PJI和无菌性松动是改良TKA后假体失败的最常见原因。一个悬而未决的问题是患者的性别对修复术后长期假体存活的影响。此外,尚不清楚与性别相关的参数和危险因素或治疗的差异是否导致翻修关节置换术后结果的潜在差异。患者和方法:本报告回顾性分析109例因PJI而行TKA翻修手术的患者。我们通过临床、临床旁和影像学检查来研究性别对PJI依赖关节置换术后无菌性松动和复发性PJI的长期并发症的影响。结果:虽然假体总体失败率和复发性PJI的风险在性别之间没有差异,但女性患者无菌性松动的长期风险显著升高。对于后来诊断为无菌性松动的女性,术后冠状位排列明显更容易内翻。除了冠状排列外,没有观察到临床表现或治疗的性别差异。结论:女性患者在pji依赖性改良TKA后出现无菌性松动的风险显著增加。在我们的研究中观察到的长期结果的性别依赖差异支持了有关骨代谢在无菌性松动发展中的作用的理论。我们的数据表明,有必要进一步研究女性pji依赖修复假体的设计。
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Influence of Gender on Occurrence of Aseptic Loosening and Recurrent PJI after Revision Total Knee Arthroplasty
Background: Periprosthetic joint infection (PJI) is a common yet severe complication after total knee arthroplasty (TKA). Surgical intervention and antibiotic therapy are obligatory to achieve successful, infection-free outcome. Compared to the outcomes after primary TKA, prosthesis failure rates are drastically increased after PJI-dependent revision surgery. Recurrent PJI and aseptic loosening are the most common reasons for prosthesis failure after revision TKA. An open question is the influence of the patients’ gender on long-term prosthesis survival after revision surgery. Additionally, it is unknown whether gender-related parameters and risk factors or differences in treatment are responsible for potential differences in outcome after revision arthroplasty. Patients and Methods: In this report, 109 patients that received TKA revision surgery due to PJI were retrospectively analyzed. We used clinical, paraclinical and radiological examinations to study the influence of gender on the long-term complications aseptic loosening and recurrent PJI after PJI-dependent revision arthroplasty. Results: While overall prosthesis failure rates and risk of recurrent PJI did not differ between genders, the long-term risk of aseptic loosening was significantly elevated in female patients. Postoperative coronal alignment was significantly more varus for women later diagnosed with aseptic loosening. Besides coronal alignment, no gender-dependent differences in clinical presentation or treatment were observed. Conclusions: Female patients displayed a significantly increased risk for aseptic loosening after PJI-dependent revision TKA. The observed gender-dependent differences in long-term outcome in our study support theories surrounding the role of bone metabolism in the development of aseptic loosening. Our data suggest that further research on a female design for PJI-dependent revision prostheses is warranted.
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Clinical Osteology
Clinical Osteology Medicine-Endocrinology, Diabetes and Metabolism
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