Abstract
Objective
The aim of this study was to investigate the clinical results of treatment for patients with periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) in our department.
Patients and Methods
Between April 2004 and March 2014, 9 patients with rheumatoid arthritis (RA) and 6 patients with osteoarthritis (OA) were identified as PJI following TKA and treated in our hospital. We investigated retrospectively the data of each patient, including the clinical background and the peri-operative data as well as the outcome at final follow-up.
Results
The mean duration between the TKA and the onset of PJI was 5.8 years (1–234 months), and 3 cases were PJI within 1 year following TKA. In RA patients, 5 of 9 patients used glucocorticoids and the mean dosage was 4.4 mg per day (2–8 mg) and 4 of 9 patients were treated by using biologics. Intensive irrigation and synovectomy was done in 11 patients, one-stage revision surgery in 2 patients, removal of prosthesis with antibiotic-containing cement spacer in 1 patient, and treated conservatively in 1 patient due to severe renal dysfunction. At the final follow-up, the knee prosthesis was survived in all patients except the removal case. However, continuous usage of oral antibiotics were needed for long period to avoid recurrence of infection.
Discussions and Conclusions
PJI is one of the most serious problems following total joint arthroplasty and intensive treatment was usually applied to control infection. This study showed that surgical intervention such as intensive irrigation and synovectomy was useful for treatment PJI. Although it remains controversial whether one-stage or two-stage revision surgery is suitable for treatment of PJI following TKA, one-stage revision surgery was useful in our cases. Because 12 of 15 cases were PJI more than 1 year after TKA, we should consider the risk of late-onset infection, especially in RA patients with usage of glucocorticoids or biologics.
