Clinical Effect Of Staged Joint Replacement In End-stage Septic Arthritis Of The Knee

Objective: To observe the clinical efficacy of first stage debridement and second stage artificial knee replacement in the treatment of end-stage septic arthritis of the knee.Methods: From September 2015 to March 2018,11 patients(4 males,6 females)with end-stage septic arthritis of the knee underwent Staged joint replacement surgery,with an average age of 64 years and an average duration of infection of 6.7 months were transferred to our hospital after invalid treatment in other institution.We used aggressive debridement and implantation of 3D printed articulating antibiotic cement spacers with systemic chemical therapy for our patients as a first stage.Systemic antibiotic therapy is applied during the interval.This was followed by primary TKA as a second stage after 1 month withdrawal and continuous review of 2 infection indicators until they returned to normal.We assessed infection markings,knee ROM,Knee Society scores,HSS,Lysholm,and VAS scores perioperatively and during followup.Results: All the patients were followed up from 8 months to 16months(11.1months on average)postoperatively.No recurrent infections occured.The level of ESR,C-reactive protein and interleukin-6 at the final follow-up were significantly lower than before treatment.The difference was statistically significant(P <0.01).The knee HSS,KSS,Lysholm score,ROM,VAS score significantly improved compared with the preoperative level.The differences were statistically significant(P <0.01).There were two cases of poor woundhealing,no case of significant liver,kidney dysfunction,deep venous thrombosis,pulmonary embolism,cardiovascular or cerebrovascular accidents happened during the treatment.Conclusion: Through the first-stage operation of debridement and implanment of antibiotic cement spacer and second-stage operation of total knee replacement to treat end-stage suppurative knee arthritis can control infection,relieve joint pain,improve joint function and improve the quality of life for the patients.The efficacy of recent follow-up was accurate.Thorough debridement,the use of sensitive antibiotics during the interval,and the proper timing of the second-stage operation are the key to the treatment.The number of case in this study is small and the observation time is shortt.Longterm follow-up will be needed to know whether recurrent infection will occur.