原发性膝关节化脓性关节炎关节镜下滑膜切除术后一年僵硬发生率高且二次手术频繁
简介
膝关节原发脓毒性关节炎关节镜下滑膜切除术后僵硬发生率高：单中心回顾性队列纳入74例培养阳性患者，1年随访显示60.8%存在屈曲≤90°和/或伸直缺≥10°的僵硬，37.8%需无菌性再次手术（20.3%行关节松解，9.5%转为膝关节置换），且僵硬组KOOS-12评分显著更低。提示感染控制不等于功能恢复，术后应重视关节活动度监测与早期干预。
英文摘要
BACKGROUND: Native knee septic arthritis is commonly treated arthroscopically with the primary aim of infection eradication. However, the incidence of postoperative knee stiffness and the need for subsequent surgical procedures after successful treatment remain poorly defined. HYPOTHESIS: We hypothesized that, despite successful infection control, postoperative stiffness and the need for secondary surgical procedures represent frequent and clinically significant complications after arthroscopic treatment of native knee septic arthritis. METHODS: A retrospective single-centre cohort study was conducted including adult patients treated arthroscopically for culture-confirmed native knee septic arthritis between 2013 and 2022. Postoperative stiffness was defined as knee flexion ≤90 ° and/or extension deficit ≥10 ° at 1 year after infection eradication. Range of motion was assessed using standardized clinical goniometric measurements. Secondary outcomes included aseptic reoperations, arthrolysis, conversion to total knee arthroplasty, and Knee injury and Osteoarthritis Outcome Score (KOOS-12). Associations between patient-, infection-, and surgery-related variables and outcomes were analysed. RESULTS: Eighty-two patients met the inclusion criteria. Seventy-four had available 1-year follow-up data and were analysed for the primary outcome. Among these 74 patients, mean follow-up was 45.5 ± 28.4 months (range, 12-123). At 1 year, 45/74 patients (60.8%) met at least one stiffness criterion. Flexion ≤90 ° and extension deficit ≥10 ° occurred in 27/74 (36.5%) and 22/74 (29.7%), respectively. Mean flexion was 105.9 ° ± 16.8 (range, 60-130), and mean extension deficit was 4.9 ° ± 5.3 (range, 0-20). Aseptic reoperation was required in 28/74 patients (37.8%), including arthrolysis in 15/74 (20.3%) and total knee arthroplasty in 7/74 (9.5%). Kaplan-Meier aseptic-reoperation-free survival was 77.0% (95% CI, 65.7-85.0) at 12 months and 60.6% (95% CI, 48.1-70.9) at 45 months. Final KOOS-12 was significantly lower in patients with stiffness than in those without stiffness (65.3 ± 17.3 vs 80.0 ± 15.5; p < 0.001). CONCLUSION: Postoperative stiffness is a frequent and clinically relevant complication following successful arthroscopic treatment of native knee septic arthritis. Successful infection eradication was not systematically synonymous with complete functional recovery, and secondary surgery was frequently required during follow-up. LEVEL OF EVIDENCE: Level IV, retrospective cohort study.