Our experience in the management of periprosthetic knee joint infection

Kliushin N.M., Ababkov I.V., Ermakov A.M.

Abstract


Purpose
Clinical substantiation of the effectiveness of the differentiated use of surgical techniques and technical means of fixation in the treatment of patients with periprosthetic infection that consider the local status of bone tissue and para- articular tissues.
Materials and methods
The work is based on the experience of surgical treatment of 97 patients with periprosthetic infection of the knee joint in the period from 2004 to 2016. Depending on the degree of bone damage after removal of implants, the patients were divided into three groups. The first one (n = 32; 33%) had type F1 and T1 bone defects according to AORI classification (Anderson Orthopedic Research Institute, USA); the second one had type F2A and T2A (n = 16; 16.5%), F2B and T2B
(n = 26; 26.8%); the third one had F3 and T3 (n = 23; 23.7%). In the first group, only debridement was used. The second group patients underwent a two-stage revision with the installation of a spacer. The third group had arthroplasty in combination with osteosynthesis with the Ilizarov apparatus.
Results
Positive outcomes in patients of the first group were achieved in 100 % of cases, in patients of the second group in 82.5%, and in the third one in 92.2%. Complications happened in 30.9% of cases.
Conclusion
A differentiated approach with a multifactorial analysis of the infection causes, taking into account the risk factors, associated diseases that aggravate the infectious process, of the state of the implant and para-articular tissues, as well as the type of pathogen, its virulence and sensitivity to antibiotics is an effective rehabilitation option for managing patients with deep infection developed around the implant.

Keywords


knee joint, implant, infection, debridement, revision arthroplasty, joint replacement, Ilizarov apparatus, antibiotic therapy

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DOI: http://dx.doi.org/10.18019/1028-4427-2019-25-2-162-171

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