EFFECTS OF ‘DEAD SPACE’ REDUCTION ON RESULTS OF INFECTED COMPLICATIONS TREATMENT IN JOINT REPLACEMENT

Abstract

Introduction. The problem of prophylaxis and treatment of infected complications after total joint replacemt is relevant today, especially in case of revision procedures. The important factor in successful preventive maintenance and treatment of purulent complications is reduction of so-called ‘dead space’ of the operated joint usually filled with a haematoma. Traditionally reduction of this ‘dead space’ has been surgically approached, for example, by filling the cavity of a joint with muscular tissue.

The purpose of this study is to analyze the effects of different methods of ‘dead space’ reduction in treatment of infected complications in total joint replacement.

Materials and methods: Follow-up results of 237 operations for treatment of infected hip and knee joints have been studied. Patients were observed from 2 to 12 years (average 7 years). 3 groups of patients have been allocated. The first group (87 patients) was formed by patients with signs of early infected postoperative complications after total hip or knee joints arthroplastics. In this group only debridement of necrotic tissues was performed. The second group (48 persons) consisted of patients with signs of a chronic infection after total joint replacement. In all these patients, after removal of the purulent and necrotic tissues, the one-stage revision was carried out. The third group included 102 patients who underwent a two stage revision and application of the articulating spacer. In each group two methods? of ‘dead space’ reduction – muscular tissue tamponade or filling of articular cavity by Taurolin-Gel 4% – were performed. Depending on the volume of joint and intramedullary cavity at operation, 50 to 100 g of Taurolin-Gel were used.

Results: Between all the groups the infection recurrence was observed in 21 patients (8,86%). The best results were observed in patients with early infection and in cases of two stage revisions. On the average, filling the joint cavity with Taurolin-Gel during revision surgery, in contrast to the muscular tissue tamponade, reduced the frequency of repeated infected complications by the factor of 1,6.

Discussion: Taurolin-Gel 4%, inserted into joint cavity, acts not only as a haematoma displacement, but also as a good antibacterial agent. It creates a depot of the antimicrobic medicine directly in the pathological center. By deleting a hematoma, we sharply reduce the risk of infectious complications in the postoperative period. Besides, Taurolin-Gel reduces postoperative blood loss by approximately 30%, causing mechanical haemostasis by the tamponade.

Conclusions: In contrast to filling a joint cavity with muscular tissue, using Taurolon-Gel 4% is much easier technically, more effective in reducing the infection occurrence, greatly reduces the time of revision intervention, and reduces the general traumaticity of operations.