Qiao YJ, Li F, Zhang LD, Yu XY, Zhang HQ, Yang WB, Song XY, Xu RL, Zhou SH. Analysis of the clinical efficacy of two-stage revision surgery in the treatment of periprosthetic joint infection in the knee: A retrospective study. World J Clin Cases 2022; 10(36): 13239-13249 [PMID: 36683646 DOI: 10.12998/wjcc.v10.i36.13239]
Corresponding Author of This Article
Sheng-Hu Zhou, PhD, Doctor, Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, No. 333 Nanbinghe Road, Qilihe District, Lanzhou 730050, Gansu Province, China. zhoushenghu120@163.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yong-Jie Qiao, Xin-Yuan Yu, Hao-Qiang Zhang, Wen-Bin Yang, Xiao-Yang Song, Rui-Ling Xu, Sheng-Hu Zhou, Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
Feng Li, Department of Orthopedics, The 943rd Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Wuwei 733000, Gansu Province, China
Lv-Dan Zhang, Department of Respiratory Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
Author contributions: Qiao YJ, Li F and Zhang LD contributed equally to this work; Qiao YJ, Li F and Zhang LD designed the study, collected data, performed the statistical analysis, and wrote the manuscript; Zhang HQ and Yu XY assisted with data collection; Yang WB drafted the manuscript; Zhang HQ and Song XY helped with data interpretation and critically reviewed the manuscript; Zhou SH conceived of the study, helped with data interpretation, and critically reviewed the manuscript; All the authors read and approved the final manuscript.
Institutional review board statement: Formal institutional approval was not deemed necessary since anonymised data routinely collected in our centre for clinical practice purposes were used.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Hu Zhou, PhD, Doctor, Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, No. 333 Nanbinghe Road, Qilihe District, Lanzhou 730050, Gansu Province, China. zhoushenghu120@163.com
Received: August 10, 2022 Peer-review started: August 10, 2022 First decision: November 11, 2022 Revised: November 15, 2022 Accepted: December 5, 2022 Article in press: December 5, 2022 Published online: December 26, 2022 Processing time: 138 Days and 10.7 Hours
Abstract
BACKGROUND
Periprosthetic joint infection (PJI) is a catastrophic complication that can occur following total knee arthroplasty (TKA). Currently, the treatment for PJI mainly includes the use of antibiotics alone, prosthetic debridement lavage, primary revision, secondary revision, joint fusion, amputation, etc.
AIM
To explore the clinical effect of two-stage revision surgery for the treatment of PJI after TKA.
METHODS
The clinical data of 27 patients (3 males and 24 females; age range, 47–80 years; mean age, 66.7 ± 8.0 years; 27 knees) with PJI treated with two-stage revision surgery in our hospital between January 1, 2010 and December 31, 2020 were analyzed retrospectively. The following outcomes were compared for changes between preoperative and last follow-up results: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores, knee range of motion (ROM), and infection cure rates.
RESULTS
All 27 patients were followed up (range, 13–112 mo). The ESR (14.5 ± 6.3 mm/h) and CRP (0.6 ± 0.4 mg/dL) of the patients at the last follow-up were significantly lower than those at admission; the difference was statistically significant (P < 0.001). The postoperative VAS score (1.1 ± 0.7), HSS score (82.3 ± 7.1), and knee ROM (108.0° ± 19.7°) were significantly improved compared with those before the surgery; the difference was statistically significant (P < 0.001). Of the 27 patients, 26 were cured of the infection, whereas 1 case had an infection recurrence; the infection control rate was 96.3%.
CONCLUSION
Two-stage revision surgery can effectively relieve pain, control infection, and retain good joint function in the treatment of PJI after TKA.
Core Tip: The two-stage revision surgery approach, which includes the first stage of thorough debridement, removal of prosthesis, antibiotic bone cement placeholder exclusion for 3–6 mo, three normal consecutive routine blood examination results for erythrocyte sedimentation rate and C-reactive protein, selection of a suitable prosthesis for the second-stage revision, and the use of a sufficient amount of a full course of sensitive antibiotics, is a reliable method for the treatment of periprosthetic joint infection after total knee arthroplasty A. This approach can effectively relieve pain, control infection, and preserve good joint function.
