| Background:At present,the total knee arthroplasty(TKA)has been widely used in all kinds of severe knee patients.Among them,the periprosthetic joint infection(PJI)after TKA is the most common and serious complication,and the treatment is difficult,which brings great pain to patients and physicians.The infection rate after primary knee replacement was 1%to 2%.For late infection,the two-stage revision is considered the"gold standard"for the treatment of PJI after TKA.Objective:To explore the clinical effect of the two-stage revision surgery in the treatment of PJI after the TKA,summarize the treatment experience,and give a reference for clinical work.Methods:?Retrospective analysis of 34 patients who undergoing two-stage revision of PJI after TKA in the period from February 2011 to February 2016.Complete follow-up data were obtained from 15 males and 19 females,the mean age of all cases was 61.3years(range from 51-77),16 left knees and 18 right knees.The average BMI is 26.1kg/m~2(19.1-32.7).There were 11 patients with diabetes,18 patients with hypertension,8 patients with coronary heart disease,and 6 patients with cerebrovascular disease.Three patients were infected after knee replacement in our hospital for the first time.The remaining 3 patients were treated for the first time after they had undergone joint replacement in the external hospital.All patients underwent two-stage revision surgery.The first stage of surgery was completely debrided,and foreign bodies such as joint prostheses and bone cement were removed and functional vancomycin cement implants were implanted.In the interval,the patient can be partially loaded early,the joints are normally active,sensitive antibiotic treatment was choosed.The second stage surgery for implanted revision prosthesis was taken after infection control.All patients were followed up regularly,and the effects were evaluated by infection control rate,symptoms and signs,HSS score,VAS score,knee joint activity,etiology results,laboratory examination and imaging examination.Results:The average follow up time for 34 cases was 34 months(range 24-60).HSS was significant increased from preoperative 38.38±10.47 point to the last follow-up after the operation 84.65±17.49 point.VAS was significant decreased from preoperative6.94±0.81 point to 0.88±1.81 point and the range of motion were improved after revision from 74.71±20.63 to 94.15±20.73.By comparing the preoperative and postoperative HSS,VAS and ROM scores,the results of this study were statistically significant(P<0.01).Thirty-two of the 34 patients were cured of infection,2 had recurrent infections,and the infection control rate was 94.1%.Conclusions:At present the two-stage revision surgery is the best method for the treatment of PJI after TKA,which can effectively control the infection,relief the pain and has a higher infection control rate.The application of homemade joint vancomycin bone prosthesis,scientific analgesia and reasonable knee joint function exercise play an important role in the recovery of knee joint function after the two-stage revision. |
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