| Objective To analyze the outcomes characteristics of two-stage revision arthroplasty in the treatment of infection after total hip arthroplasty and total knee arthroplasty(THA,TKA)in our joint replacement treatment center;Factors associated with achieving optimal outcomes in revision therapy.Methods Retrospectively collected 60 patients with infection after hip and knee arthroplasty from January 2013 to March 2018.All patients underwent two-stage revision surgery.Inclusion criteria: Patients with debridement and insert spacers with chronic infection after primary joint replacement in our institution,12 patients were excluded due to infection after joint revision,other infectious diseases or non-chronic infections,and 48 chronic cases were eventually included.In patients with Periprosthetic Joint Infection,32 cases were infected after hip joint replacement and 16 cases were infected after knee joint replacement.The stent was followed for at least 1 year after implantation.During the follow-up period,the patient’s prosthesis replantation and postoperative infection control,joint function recovery,additional surgery and re-renovation were analyzed.The hip and knee scores of the preoperative and postoperative follow-up of each index were compared using a paired t-test.The Kaplan-Meier survival method was used to assess infection-free survival after Spacer insert.Results A total of 46 patients(30 hips,16 knees)were followed up for a complete follow-up of 95.8%,with a mean follow-up of(27 ± 15)months.The success rate of treatment was 95.7%(44/46),Antibiotic cement spacers were placed after thorough debridement and removal of the infected prosthesis.Except for 2 patients with knee infection who used non-articular spacers,the other patients used articulated spacers.Twenty-eight patients underwent replantation of the prosthesis,and 2 patients underwent debridement of superficial soft tissue due to poor healing of the incision.One patient had joint dislocation due to joint dislocation,incision dehiscence,and debridement surgery.Healing,infection control.One patient died of non-infectious disease during the follow-up period.The remaining patients had no infection recurrence and joint loosening.The preoperative Harris score was(45.8±6.5)points,the KSS score was(49.4±4.7),and the Harris score was(85.7±7.5)points,the KSS score was(87.3±3.5),and the difference was statistically significant(P<0.05).Eighteen patients(39.1%)(13 hips,5 knees)underwent secondary surgery because of infection control,conscious functional refusal to re-operation,or inability to tolerate surgery due to comorbidities.In 2 patients,the infection persisted after the implantation of the spacer.One patient removed the spacer and the remaining 16 patients were infected.Five patients had poor healing of the incision,and 10 extra soft tissue debridement operations were performed.At the end,1 patient died of cirrhosis after operation,and 12 patients were satisfied with their joint function.(Harris score≥80,KSS score≥70).Conclusions Most patients with chronic infection after hip and knee arthroplasty can effectively control infection and restore joint function to a greater extent after the exact two-stage revision treatment.In some patients,postoperative infection control and joint function were not performed due to the placement of the joint type antibiotic cement spacer.Patients with retention joint spacers were able to obtain satisfactory joint function in the short to medium term.Optimized culture and application of multiple pathogen detection methods can improve the success rate of second-stage revision surgery.The use of joint spacers is beneficial to postoperative functional recovery. |
PDF Full Text Request