Diagnosis And Therapy Analysis Of10Patients’12Knees Of Infection After Total Knee Arthroplasty

Objective: The purpose of the current study is to research the infective rate aftertotal knee arthroplasty(TKA) between Januar，2006and April，2013in ourhospital.And analysis of diagnosis and therapy process of infection after TKA of10patients’12knees during the same period.Finally,we discuss the appropriate diagnosismethods and affective therapeutic methods.Methods: During Januar，2006and April，2013,our hospital has received andcured284patients’382knees to perform TKA,with6patients’7knees infected afterdifferent periods.And during the same time,our hospital has received and cured4patients’5knees infection after TKA,who performed TKA in other hospitals. Weretrospectively reviewed the diagnosis methods,therapeutic methods and the outcomesof the infection after TKA of10patients’12knees.The main diagnosis methodsinclude:detailed asking of history,physical examination,association with laboratoryexamination,for instance,blood routine examination,and other specificexaminations,including ESR,CRP,culture of synovial fluid,intraoperative frozen sectionhistopathology and so on.In our research,5patients’6knees received the systemicantibiotic therapy,with2patients’3knees didn’t be controlled then received two-stagerevisions;3patients’3knees received prosthesis-remained debridement， jointconvection flushing combinated with systemic antibiotic therapy,with1patient’s1kneedidn’t be controlled then received two-stage revisions;2patients’3knees receivedone-stage revision,with1patient’s2knees didn’t be controlled then received two-stagerevision secondly；4patients’5knees received two-stage revision,all failed from othertherapeutic methods.Results:5patients’5knees have been controlled with prosthesis remained,and5patients’7knees have been controlled after revisions.After treatment in our hospital,allof the infections were controlled effectively,and all of the joint functions were recovered. During the average follow-up time of13.3months (1-31months),there is noreinfection occured.Conclusion: The doctors should suspect infection with the patient who has a painin the knee just after the surgery of TKA seriously,until the diagnosis isdeterminated.The diagnosis of infection after TKA should combine ofhistory,symptom,sign and physical examination.The main symptom is persistentpain,with different levels of limitation of motion,swelling of joint,skin flush,highertemperature of skin,local tenderness,incision drainage,fever and other systematicsymptom,but in this research there is no ulceration or sinus tract.And particularlaboratory examinations criteria include ESR/CRP persistent elevation, find pathogenicbacterium during culture of synovial fluid,or find≥10polymorphonuclear leukocytes(PMNs) per high-power field in intraoperative frozen section histopathology,which isthe “Gold standard” of infection after TKA. The main therapeutic methods include:systemic antibiotic therapy,prosthesis-remained debridement conbined with jointconvection flushing; one-stage revision and two-stage revisions,and the two-stagerevisions with antibiotic-loaded bone cement is the most effective therapeutic method toeradicate the infection.Meanwhile every therapeutic method has its ownindications,advantages and disadvantages,and all the factors of the patients should beconsidered before making the specific therapeutic strategy.