After Total Knee Arthroplasty Infection Risk Factors And Treatment Measures

【Objective】To retrospectively analyze the relation between the infective rate and high risk factor and curative effects of revision.【Methods】A total of 1103 patients received TKA in PUMCH from 1995 to 2008,including 18 patients infected.Patients were respectively diagnosed as osteoarthritis(OA),rheumatoid arthritis(RA).To retrospectively analyze the relation between the infective rate and high risk factor,including age,gender,diagnosis,one-side or two-sides exchange, hypertension history and diabetes mellitus history.Follow-up was conducted on patients that mentioned at average 55.1 months.Investigation and comparison on pain-degree, range of knee joint activation.Knee joints were scored by using knee joint scoring of American special surgical hospital(HSS) and the western Ontario and McMaster universities osteoarthritis index(WOMAC).【Results】The infection rate is 1.63%from 1995 to 2008,male patients' infection rate is 1.35%,female patients' infection rate is 1.70%.The infection rate of the patients whose age between 50 to 65 is 1.68%.The infection rate of patients whose age between 65 to 80 is 1.84%.There is no patient infected beyond 80.The infection rate of osteoarthritis is 1.5%.The patients' infection rate of rheumatoid arthritis is 3.4%.One-side exchange and both-side exchange's infection rate are 1.0%,4.8%.The patients with hypertension only occurred infection about 3.8%.There is no patient infected with diabetes mellitus only. The patients with both hypertension and diabetes mellitus occurred infection about 10.3%,the others without hypertension and diabetes mellitus are 1.03%.Hypertension and Diabetes mellitus will increase the infection rate,so dose the both-side exchange.There is seven patients receiving debridement,two(28.6%) of them controlled the infection.There is three patients receiving one-stage revision.Eleven patients got two-stage revision.There is no infection arised after revision.Function of patients after operation were obviously ameliorated.The pain of knee,scores of HSS,scores of WOMAC were markedly ameliorated than those before operation(P＜0.01).According to the result,the curative effect of two-stage is better than one-stage revision. 【Conclusion】The hypertension,diabetes mellitus and both-side exchange will increase the infection rate.Get ready of operation and limit the both-side exchange to prevent infection.According to the low infective control rate,the debridement is not suggested. One-stage revision can release both mentally and economic burden.But the curative effects of revision is not ascertainment.The main treatment to TKA infection is two-stage revision.Two-stage revision can acquire high infective control rate.The pain of knee and function of patients after operation were obviously ameliorated.If infection ascertained, two-stage revision is recommended.