Infection After Total Knee Arthroplasty Issue Revisionindications And Curative Effect Analysis

Background and objective:Total knee arthroplasty(TKA) terminal knee joint disease caused by various reasons had a significant and exact curative effect, is the ultimate solution to a terminal disease, and the only way. Total knee arthroplasty can obviously improve the patient’s knee joint activity function, relieve knee pain, correct knee flexion contracture deformity, or inside and outside to improve the quality oflife. But this operation method has some difficult to deal with complications, including infection around the joint prosthesis is a "catastrophic" complications. Bring to the patient and family to a heavy psychological burden and the greateconomic burden. For medical personnel also brought unnecessary stress. Aroundthe implant infection treatment has a lot of, how to choose the most suitable for the patient’s treatment has become a joint surgery constantly explore the topic.This paper mainly discusses the artificial knee joint arthroplasty infection after a period of revision surgery indications and therapeutic effect Methods:to retrospective study to choose from May 2002 to May 2002 in 10 years, were artificial knee joint arthroplasty infection in patients with an overhaul of the selected, a total of 19 cases,5 patients with men, 14 patients with women, average age at the age of(67 + 7). 19 patients have knee pain symptoms, limited activity, local skin temperature increased, the skin color is unusual, blood sedimentation(ESR) are greater than 30 mm/h, C reactive protein(CRP) were greater than 10 mg/l. 9 patients without diabetes, moderately severe anemia and low protein and tumor risk factors of infection, such as skin fistula formation, 5 cases were examined by preoperative etiology for staphylococcus aureus infection, 3cases of epidermis staphylococcus infection, 1 cases of gram negative bacillus infection(all for a single bacterium group, not mixed infection), to select a period of revision surgery. More than 10 patients choose phase ii revision procedures. All patients who found inflammatory granulation tissue around the implant and visible to the naked eye pus moss, intraoperative take pus moss again do bacterial and fungal culture and drug susceptibility test. 9cases a revision surgery were thorough debridement, remove the prosthesis, with hydrogen peroxide solution, iodine volts water invasion bubble pulse pressure gun and a large number of saline water irrigation, replacement equipment and gloves at the same time, placing the sterile towels, in order to contain vancomycin, tobramycin and gentamicin fixed new bone cement prosthesis. Postoperative intravenous input sensitive antibiotics 2 weeks later, oral antibiotics instead of 4 to 6 weeks. 10 cases revision procedures also go thorough debridement, phase ii, out with hydrogen peroxide solution, iodine volts water invasion bubble pulse pressure gun and a large number of saline water irrigation, replacement equipment and gloves at the same time, placing the sterile towels, in order to contain vancomycin, tobramycin and gentamicin bone cement filling. Postoperative blood routine, periodic review of blood sedimentation(ESR) and c-reactive protein(CRP), check the skin conditions and joint function. Using HSS knee scoring criteria to assess the clinical therapeutic effect. Results: Patients treated in 9 issue of overhaul, heal wounds were stage I, including 2 cases of recurrence of infection when 5 months after surgery, again give surgery, infection can control effectively.10 patients with phase ii of renovated kuang a postoperative wound healing, 3-9 months after two stages, including 2 cases in overhaul postoperative recurrence in June, reoperation.Overhaul followed for an average of 23.8 months after surgery.2 groups on the change trend of the ESR and CRP there was no significant difference;HSS knee score from an average of 33.6 points preoperatively, increased to an average of 81.2 points at the time of final follow-up.No difference between the two kinds of operation method in statistics(P > o. 05). Conclusion:(1) issue of revision procedures in the treatment of postoperative infection TKA is feasible.(2) the TKA revision procedures of selection issue of postoperative infection indication: single bacterial infections, fungal infection, with sensitive antibiotics;Bone and soft tissue condition good;Patients at high risk of infection factors;Less than two skin fistula formation.