Short Result Of Two-Stage Revision In Treatment Infection Of Total Joint Arthroplasty

Objective:To evaluate the short-term results two-staged revision using antibiotic-loaded bone cement spacer for treatment of infected total joint arthroplasty.Methods:From January 2012 to July 2014,22 cases(include hip and knee) were enrolled in this retrospective study.13 cases were hip joint(7 males,6 females),9 cases were knee joint(4 males,5 females).Theses patients’mean age is 63.8(from 45 to 71). The pathogeny for 13 cases primary hip arthroplasty were femoral head necrosis,developmental dysplasia of the hip,femoral neck fracture and osteoarthritis of hip. The pathogeny for 9 cases primary knee arthroplasty were osteoarthritis of knee and reheumatoid arthritis.22 patients’main clinical manifestation were joint and activity limitation,some of them with sinus.For suspicious patients, preoperative serum examination,imaging examination,synovial fluid analysis and culture and so an are using in diagnosing periprosthetic infection.The treatment consisted of a two-stage surgery,first stage surgery:removement of all implants,debridement of all infected tissue,cement and hardware.and insertion of antibiotic-loaded bone cement spacer.After infection was controlled,we undergo second stage surgery:removement of bone cement,debride again and implantation of new prosthetic joint.Follow-up data obtained by outpatient and telephone,the mean postoperative follow-up was 14.7 months,Using the Haris score, HSS score, X-ray to evaculate revison effection.Result:All operations were successful,without complications occurred.All patients were followed up for 6-24 months(averaged 14.7 months).No recurrent infection was found.The bacterial culture results of 13 cases of PHI:5 cases negative results,4 cases were Staphylococcus aureus,3 cases were Staphylococcus epidermidis,1 cases were Streptococcus; The bacterial culture results of 9 cases PTI:3 cases negative results,3 cases was Staphylococcus aureus,3 cases were Staphylococcus epidermidis, 1 cases was Coagulase negative Staphylococcus.13 cases of PHI patients’preoperative Harris score was 24-36,averaged 28.5,postoperative Harris score was 81-94,averaged 88.9;9 cases of PKI patients’ preoperative HSS score was 28-49,averaged 41.6;postoperative score was 76-93,the average was 86.2,The score of preoperation and postaoperation were statistically significant (P<0.01).Conclusions:Two-stage revision is an effective and useful way to eradicate the infection and improve the postoperative function of joint in treatment of PJI.