SURGICAL AND CLINICAL OUTCOMES FOLLOWING MANAGEMENT OF TOTAL KNEE ARTHROPLASTY PERIPROSTHETIC JOINT INFECTION WITH EXTENSOR MECHANISM DISRUPTION AND SOFT-TISSUE DEFECT: THE KNEE ARTHROPLASTY TERRIBLE TRIAD
Notice bibliographique
Résumé
Periprosthetic infection (PJI) with concomitant extensor mechanism disruption (EMD) and soft tissue defect – hereinafter termed the “Terrible Triad” – is a devastating complication following total knee arthroplasty (TKA). The purpose of this study was to define the surgical and clinical outcomes following management of patients with the Terrible Triad. From 2000 to 2022, 127 patients underwent operative management for PJI, 25 for PJI with major soft tissue defect (defined as defects requiring flap reconstruction or being a main factor contributing to the decision of performing above-knee-amputation (AKA) or arthrodesis), 14 for PJI with EMD (with or without attempted repair or reconstruction), and 22 for the Terrible Triad. A composite outcome considering infection status (defined according to the 2018 ICM consensus statement for PJI management), range of motion (ROM), extensor lag, and ambulatory status at final follow-up was used to determine the proportion of patients in each group with a favorable overall knee outcome and compared across groups (Table 1) [1]. Two-year mortality from initiation of PJI treatment was compared across groups. Differences in continuous data were assessed using one-way ANOVA and Tukey's post hoc test. Differences in categorical data were assessed using Pearson's Chi-squared test or Fisher's exact test. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). The Kaplan-Meier survival analysis and log-rank test were used to assess mortality. Statistical significance was set at α=0.05. Mean duration of follow-up was 7.71 years and equivalent between groups (p=0.053). Patients in both the Terrible Triad group and PJI with soft tissue defect group demonstrated lower incidence of infection control with no continued antibiotic therapy and higher incidence of AKA or arthrodesis (Tier 3E) compared to patients in both the PJI group and PJI with EMD group (p<0.001), and higher incidence of limited ambulation compared to those in the PJI group (p<0.001). Patients in the Terrible Triad group demonstrated higher incidence of ROM arc <90° than those in the PJI group (p=0.031), and higher incidence of extensor lag >15° than those in the PJI group and PJI and soft tissue defect group (p<0.001) (Table 2). Patients in the PJI with soft tissue defect, PJI with EMD, and Terrible Triad groups showed higher odds of unfavorable overall knee outcome than those in the PJI group (OR=5.81, OR=5.50, OR=11.61, respectively). Mean two-year mortality was 7.8%, 8.0%, 42.9%, and 9.1% in the PJI, PJI with soft tissue defect, PJI with EMD, and Terrible Triad groups, respectively (p=0.472). Symbols (§, †, ‡, ¶) within a row indicate statistically significant differences between two groups as determined by Tukey's post hoc test following one-way ANOVA for continuous data and chi squared test or fisher's exact test for categorical data. This study demonstrates that the Terrible Triad of TKA is a dreaded diagnosis with poor outcomes, leaving 86.4% of patients with an unfavorable overall knee outcome. Patients should be warned of high risk for failure with multiple revisions during their management. Early treatment with definitive fusion or AKA should be considered by patients and surgeons. For any figures or tables, please contact the authors directly.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».