Treatment for Infected TKA.

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  • 人工膝関節置換術後の感染に対する治療

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Abstract

We report problems in treating infected Total Knee Arthroplasty (TKA) based on our experience of 7 knees.<BR>Seven cases (7 knees), with infection after TKA, were studied. The original joint diseases were 5 knees with OA, 1 knee with RA, and 1 knee with osteonecrosis combined with SLE. All cases had a history of multiple surgeries including the infected knee. Infected implants were observed in 2 LCS, 1 Rotating-Hinge, 1 AMK, 1 Deltafit 7000, 1 Scorpio, and in 1 MGII which was removed by another hospital. Detected microorganisms were MRSA in 2, MSSA in 2, and MRSE in 1. Surgical treatment for these infected knees involved removal of the implant, debridement of infected tissue, insertion of cement blocks including antibiotics, and continuous irrigation with 5 liters of physiological saline and 1 liter of oxidizing water for 2 weeks. Revised TKA or arthrodesis was performed on patients several weeks after continuous irrigation. Four knees had revised TKA, 3 knees had arthrodesis, and 1 patient underwent above-knee amputation after arthrodesis. The mean follow-up period after surgery was 19 months.<BR>None of the patients had any symptoms of infection at follow-up. Good bony union was achieved in 2 of the arthrodesis cases. The mean ROM of revised TKA was 65 degrees. ESR value, CRP value, and the number of white blood cells were normal in the 5 cases without RA or SLE.<BR>Multiply operated cases need strict infection prevention after TKA. In the patients with RA and SLE, it was difficult to control inflammation. Careful observation of infected knees is necessary, because of the short-term follow-up period.

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