| Background Periprosthetic Infection(PJI)is the most catastrophic complication after total knee arthroplasty(TKA).Currently,PJI after TKA is treated with antibiotics alone,one-stage revision and two-stage revision.The two-stage revision surgery,as the"gold standard"for the treatment of PJI,has the best therapeutic effect,but it also increases the patient's pain and financial burden.Self-curing calcium sulfate as a bone substitute material has the characteristics of good biocompatibility,rapid degradation and complete absorption by the body,and can be used as a good antibiotic carrier for the treatment of patients with PJI.Objective To evaluate the efficacy of self-curing calcium sulfate cement particles supplemented with antibiotics in the treatment of periprosthetic infection after knee arthroplasty.Methods Twenty-eight patients who underwent revision surgery for the knee joint infection after total knee arthroplasty(TKA)at the Qilu Hospital of Shandong University from 2013 to 2018 were selected,including 6 males and 22 females aged 53-79 years old,with an average age of 66.5 years.In terms of complications,12 patients had hypertension,4 patients with diabetes,2 patients with rheumatoid arthritis,2 patients with coronary heart disease,1 patient with ankylosing spondylitis,and 1 patient with heart disease.Among them,6 cases had bad habits such as smoking and drinking,and 10 cases were obese.All patients were treated with a one-stage revision to treat periprosthetic joint infections,and self-curing calcium sulphate cement particles with sensitive antibiotics were added to the femur,tibia bone marrow cavity and joint cavity during surgery.KSS scores of knee joints were recorded before and at 1,3,6 days and 12 months after surgery and at the end of follow-up.Patients were measured for ESR and CRP before and 3 days,5 days,1 month,and 3 months after surgery.X-rays of the knee joint were taken before surgery and at 2 days,1 and 3 months after surgery.During the follow-up period,it is necessary to record the healing of the patient's surgical incision,the skin condition of the operation area,the bright line of the patient's X-ray prosthesis,and the position of the prosthesis.Results Up to December 31,2018,all 28 patients in this study were followed up for 6 to 67 months,with an average follow-up of 33.7 months.In 27 patients,the infection was controlled,and the surgical incision healed well.The KSS score increased from 30.5 points before surgery to 85.8 points after operation(P<0.05).The average preoperative ESR was 61.4 mm/h,and the average was 9.4.mm/h(P<0.05),CRP decreased from an average of 57.3mol/L before surgery to an average of 5.1mol/L(P<0.05).The X-ray of the knee showed good position of the prosthesis and no bright line around.One patient developed recurrence of infection after surgery,and was given a revision surgery again.The self-curing calcium sulfate particles with sensitive antibiotics were applied during the operation.The knee pain disappeared after operation and the function was significantly improved.By the end of the follow-up,the patient There is no recurrence of knee infection.Conclusion Self-curing calcium sulphate particles with antibiotics in the one-stage revision can effectively control the infection around the prosthesis after joint replacement.But the results still need to be confirmed by further large-scale studies. |
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