| Background and objectiveKnee joint infection refers to intra-articular infectious diseases caused by bacteria,fungi,parasites,mycoplasma and other pathogenic microorganisms.Although the incidence of knee joint infection is relatively low,it will seriously damage the joint structure,affect joint function,and bring great physical and mental pain to patients.At present,domestic and foreign scholars’ research on knee joint infectious diseases can be divided into two categories:natural joint infection and joint replacement infection(Periprosthetic Joint Infection,PJI).The primary knee joint infection described in this paper mainly refers to the bacterial natural joint infection caused by local invasive operation,excluding joint open injury,arthroscopic and other joint surgery.The treatment of knee joint infection has always been a difficult problem for clinicians.In addition to systemic application of sensitive antibiotics,thorough cleaning of local lesions is the key to control infection.Traditionally,joint puncture and lavage is often used to discharge pus and necrotic materials.If the curative effect is not good,arthrotomy can be used to clean the joint cavity and drip and drain the wound with antibiotics.With the improvement of arthroscopic instruments and the maturity of operation techniques,arthroscopic debridement combined with postoperative lavage has become a new choice for the treatment of knee joint infection.It is controversial whether antibiotics should be used in the articular cavity after operation,but many scholars have reported the effectiveness of local application of antibiotics,in which the implantation of antibiotic-loaded calcium sulfate as a new mode of drug delivery has become the focus of clinical research.The clinical effects of antibiotic-loaded calcium sulfate implantation and continuous lavage have been confirmed in the literature,but there are few studies on the difference between the two surgical methods in the treatment of primary knee joint infection.This study collected patients with infectious knee arthritis who underwent surgery in our department from June 2017 to June 2020.On the basis of arthroscopic debridement,the clinical effects of antibiotic-loaded calcium sulfate implantation and continuous lavage in the treatment of primary knee joint infection were compared,in order to provide a reference for clinicians to choose treatment methods.MethodsThe Patients with primary knee joint infection treated by the department of sports medicine of the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2020 were retrospectively collected,and divided into two groups according to different treatment methods after arthroscopic debridement.40 patients were included in the antibiotic-loaded calcium sulfate group,and 55 patients were included in the continuous lavage group.There were 95 patients in the two groups.The patients in both groups were operated by the same chief physician of joint surgery.The follow-up time ranged from 6 to 18 months,with an average of(11.67±4.69)months.The results of bacterial culture,operation time,intraoperative blood loss,hospitalization days,hospitalization costs and other data of the two groups were recorded,as well as the recurrence of infection and postoperative complications during the follow-up period.The control of joint infection was evaluated by serum CRP concentration,ESR and WBC count on the 1st,3rd and 6th day after operation.The recovery of joint function was evaluated by Lysholm score and knee joint range of motion on the 6th day and 3rd month after operation,and the postoperative pain was evaluated by visual analogue scale on the 6th day and 3rd month after operation.Clinical data were statistically analyzed by SPSS22.0 software.The data were measured and normal distribution was expressed by mean ± standard deviation(x±s).Independent sample t-test was used for comparison between the two groups.Single-factor repeated measurement analysis of variance was used for intra-group comparison of serum CRP concentration,ESR and WBC counts at different time points after operation.Data for counting data were represented by the number of patients(n),and chi-square test was used for inter-group comparison.P<0.05 indicates that the difference is statistically significant.ResultsAll patients completed the operation successfully.The follow-up time ranged from 6 to 18 months,with an average of(11.67±4.69)months.During the follow-up period,there was no recurrence of infection and postoperative complications in the antibiotic-loaded calcium sulfate group.In the continuous lavage group,there were 4 patients with lower limb intermuscular venous thrombosis and 2 patients with infection recurrence.The positive rate of bacterial culture was 67.5%in the antibiotic-calcium sulfate group and 65.45%in the continuous lavage group.The top three pathogenic bacteria isolated from the synovial fluid of the two groups were Staphylococcus aureus,Staphylococcus epidermidis and Escherichia coli.There was no significant difference in the distribution of pathogenic bacteria between the two groups(P>0.05).There was no significant difference in intraoperative blood loss,serum CRP concentration,ESR and WBC count on the first day after operation between the two groups(P>0.05).The hospitalization days and hospitalization costs in the antibiotic-loaded calcium sulfate group were significantly lower than those in the continuous lavage group(P<0.05).The operation time in the antibiotic-loaded calcium sulfate group was significantly longer than that in the continuous lavage group(P<0.05).On the 3rd and 6th day after operation,the inflammatory indexes in the antibiotic-calcium sulfate group were significantly lower than those in the continuous lavage group(P<0.05).And on the 6th day after operation,the Lysholm score,visual analogue scale and ROM of the affected knee in the antibiotic-calcium sulfate group were better than those in the continuous lavage group(P<0.05).There was no significant difference in Lysholm score,visual analogue scale and knee joint range of motion between the two groups at the 3rd month after operation(P>0.05).The inflammatory indexes decreased continuously on the 1st,3rd and 6th day after operation Within the two groups,and there was statistical difference(P<0.05).ConclusionIn the treatment of primary knee joint infection,antibiotic-loaded calcium sulfate implantation and continuous lavage can effectively control the infection.Compared with continuous lavage,arthroscopic debridement combined with antibiotic-calcium sulfate implantation can significantly shorten the days of hospitalization,reduce the cost of hospitalization,decrease the index of postoperative inflammation faster,and help patients recover knee joint function as soon as possible.Arthroscopic debridement combined with antibiotic-calcium sulfate implantation has a good prospect of clinical application. |
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