Clinical effects of staged joint replacement in patients with septic arthritic knee
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(2020) 15:525
RESEARCH ARTICLE
Open Access
Clinical effects of staged joint replacement in patients with septic arthritic knee Ming Ni†, Jun Fu†, Tao Deng, Erlong Niu, Chi Xu, Xiang Li, Wei Chai, Guoqiang Zhang* and Jiying Chen*
Abstract Objective: To assess the clinical effect of staged joint replacement for the treatment of septic arthritic knee and the therapeutic differences between antibiotic cement beads and the tibial plateau spacer. Methods: Twenty-three patients (24 knee joints) treated with a staged joint replacement for septic arthritis knee were retrospectively reviewed between March 2014 and April 2018. At the first stage, thorough debridement and irrigation with self-made antibiotic cement beads or tibial plateau spacer were performed. After that, systemic antibiotic treatment was followed; when the infection was surely eliminated, the second-stage TKA was performed. Knee mobility (range of motion, abbreviated to ROM) and function (HSS scores system) were evaluated before surgery, in the interval period, and after joint replacement. Results: All patients finished follow-up, and the mean follow-up time was 27.3 months (12–54 months). Each group has one patient replaced with a homotypic spacer, and all patients eventually cleared the infection. None of the patients had a recurrent infection. The mobility and HSS scores of the two groups were significantly improved postoperation (p < 0.05). And there was no significant difference in the post-surgery ROM (p = 0.153) and the HSS score (p = 0.054) between the two groups. Conclusion: Staged joint replacement is an efficacious way for septic arthritic knees, whether tibial plateau spacer or antibiotic cement beads were used, which can effectively control infection and improve knee function. Keywords: Knee, Septic arthritis, Spacer, Two-staged joint replacement
Introduction Septic arthritic knee (SAK) is a relatively low-incidence disease while it has a high risk of disability and mortality [1]. There is currently no universally agreed ideal treatment strategy, and its treatment still faces great challenges [2]. Traditional treatment methods include knee incision or arthroscopic cleaning/irrigation/drainage based on systemic antibiotic treatment [3]. Even if anti-infective treatment against SAK is timely and appropriate, permanent joint destruction and persistent infections are still common [4]. For SAK cases with false infection control, rescue treatments, such as fusion and amputation, are often * Correspondence: [email protected]; [email protected] † Ming Ni and Jun Fu are co-first authors. The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, People’s Republic of China
adopted [5, 6]. In recent years, there have been occasional reports of a method similar to the second-stage revision [7–10] for the treatment of SAK, including first-stage debridement and implantation of static or articulated spacer to control infection and second-stage initial total knee replacement to restore knee function [2, 5, 11–16]. Previous relevant studie
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