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Enfekte Total Diz Artroplastisi Olgularında İki Aşamalı Revizyon Artroplastisinin Erken ve Orta Dönem Sonuçları

Year 2025, Volume: 8 Issue: 1, 19 - 24

Abstract

Amaç: Total diz artroplastisi, dejeneratif artrit gibi birçok diz hastalığının sebep olduğu ağrı ve hareket kısıtlılığını gidermek amacıyla uygulanan bir tedavi yöntemidir. Amacımız enfekte total diz artroplastisi tanılı hastalara tedavi yöntemi olarak iki aşamalı revizyon yapılanların erken ve orta dönem sonuçlarının retrospektif olarak değerlendirilmesi ve literatürle karşılaştırılmasıdır.
Gereç ve Yöntem: Bu çalışmaya Ocak 2004–2014 tarihleri arasında hastanemiz Ortopedi ve Travmatoloji kliniğinde enfekte diz protezi tanısı alan ve tedavi yöntemi olarak iki aşamalı revizyona karar verilen hastalar alındı. Hastaların laboratuvar sonuçları, radyografileri, Amerikan diz cemiyeti klinik ve fonksiyonel skorları değerlendirildi.
Bulgular: Çalışmaya 19 hastanın 20 dizi alınmıştır. Tüm hastalara iki aşamalı revizyonun birinci aşama ameliyatı yapılmış, ikinci aşama ameliyat ise 17 hastaya yapılmıştır. Enfekte total diz protezi tanısı almış 20 dizden; 3’ünde erken, 6’sında gecikmiş, 11’inde ise geç enfeksiyon tespit edilmiştir. Preoperatif klinik skor 53,29 ± 9,51 iken postoperatif 83,21 ± 9,51 (p<0,001); fonksiyonel skor ise preoperatif değer 40,88 (Sd 20,48) iken, postoperatif değer 63,23 ± 30,81 (p=0,018) olarak saptandı. Ortalama fleksiyon derecesi preoperatif ortalama 68,52° ±19,34 iken revizyon sonrası 92,64° ±16,30 çıkmıştır (p<0,001). Revizyon öncesi döneme göre tüm hastalarımızın ağrı düzeyleri azalmış ve yürüme mesafeleri artmıştır.
Sonuç: Enfekte total diz protezlerinde iki aşamalı revizyon cerrahisi; enfeksiyonu eradike etmede, postoperatif klinik ve fonksiyonel skorlar olarak literatürle uyumlu bulunmuştur.

References

  • 1.Osmon DR, Berbari EF, Berendt AR, et al. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clinical infectious diseases, 2013;56(1), 1-10. https://doi.org/10.1093/cid/cis966
  • 2.Koh CK, Zeng I, Ravi S, et al.. Periprosthetic joint infection is the main cause of failure for modern knee arthroplasty: an analysis of 11,134 knees. Clinical Orthopaedics and Related Research®. 2017;475(9), 2194-2201. https://doi.org/10.1007/s11999-017-5396-4
  • 3.Thompson O, W-Dahl A, Lindgren V, et al. Similar periprosthetic joint infection rates after and before a national infection control program: a study of 45,438 primary total knee arthroplasties. Acta Orthopaedica. 2021;1-7 https://doi.org/10.1080/17453674.2021.1977532
  • 4.Shahi A, & Parvizi J. Prevention of periprosthetic joint infection. Archives of bone and joint surgery. 2015;3(2), 72. https://doi.org/10.2106/JBJS.KS.M.00062
  • 5.Blanco JF, Diaz A, Melchor FR, et al. Risk factors for periprosthetic joint infection after total knee arthroplasty. Archives of Orthopaedic and Trauma surgery. 2020;140, 239-45. https://doi.org/10.1007/s00402-019-03304-6
  • 6. Jie Chen, Yunying Cui, Xin Li, et al. Risk factors for deep infection after total knee artroplasty: a meta-analysis, Arch Orthop Trauma Surgery. 133;675-687, 2013. https://doi.org/10.1007/s00402-013-1723-8
  • 7.Di Benedetto P, Di Benedetto ED, Buttironi MM, et al. Two-stage revision after total knee arthroplasty. Acta Bio Medica: Atenei Parmensis. 2017;88(Suppl 2), 92.
  • 8.Insall JN, Thompson F M, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. JBJS. 1983;65(8): 1087-98. https://doi.org/10.2106/00004623-198365080-00008
  • 9.Lee K, Goodman SB. Current state and future of joint replacements in the hip and knee. Expert Rev Med Devices 2008; 5: 383-93. https://doi.org/10.1586/17434440.5.3.383
  • 10.Bannister GC. İnfections in hip and knee prosthesis. Current Opinion in Orthop. 1991;2:65.
  • 11.Toossi N, Adeli B, Rasouli MR, et al. Serum white blood cell count and differential do not have a role in the diagnosis of periprosthetic joint infection. J Arthroplasty. 2012;27(8 SUPPL.):51-4. https://doi.org/10.1016/j.arth.2012.03.021
  • 12.Sigmund IK, Puchner SE, Windhager R. Serum inflammatory biomarkers in the diagnosis of periprosthetic joint infections. Biomedicines. 2021; 9(9): 1128. https://doi.org/10.3390/biomedicines9091128
  • 13.Sigmund IK, Dudareva M, Watts D, et al. Limited diagnostic value of serum inflammatory biomarkers in the diagnosis of fracture-related infections. The bone & joint journal. 2020;102(7):904-11. https://doi.org/10.1302/0301-620X.102B7.BJJ-2019-1739.R1
  • 14.Xiong L, Li S, Dai M. Comparison of D-dimer with CRP and ESR for diagnosis of periprosthetic joint infection. Journal of Orthopaedic Surgery and Research. 2019;14: 1-5. https://doi.org/10.1186/s13018-019-1282-y
  • 15.Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. The bone & joint journal. 2013;95(11):1450-2. https://doi.org/10.1302/0301-620X.95B11.33135
  • 16.Trampuz A. Widmer AF. İnfections associated with orthopaedic implants. Curr. Opin. İnfect. Dis. 2016;19:349-56. https://doi.org/10.1097/01.qco.0000235161.85925.e8
  • 17.Zimmerli W. Prosthetic joint associated infections. Best practice and research. 2006;20:1045-63. https://doi.org/10.1016/j.berh.2006.08.003
  • 18.Brause BD. Mandell GL, Bennett JE, et al. Principles and Practice of Infectious Diseases. 7th edn. Philadelphia: Elsevier; 2010. Infections with Prostheses in Bones and Joints; pp. 1469-74.
  • 19.Sönmez MM, Berk A, Ugurlar M. et al. Midterm clinical and radiological outcomes of total knee arthroplasty. Şişli Etfal Hospital Medical Bulletin 2016;50(2):115. https://doi.org/10.5350/SEMB.20160315022015
  • 20.Evans, J. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. The Lancet.2019;393.10172:655-63. https://doi.org/10.1016/S0140-6736(18)32531-5
  • 21.Walker RH. Management of infected total knee arthroplasties. Clin. Orthop. 1994;186:81-9. https://doi.org/10.1097/00003086-198406000-00014
  • 22.Haleem AA. Mid term to long term fallowup of two stage reimplantation for infected knee artrhroplasties. Clin. Orthop. and Related research. 2004;428:35-9. https://doi.org/10.1097/01.blo.0000147713.64235.73
  • 23.Petis SM, Perry KI, Mabry TM, et al. Two-stage exchange protocol for periprosthetic joint infection following total knee arthroplasty in 245 knees without prior treatment for infection. JBJS. 2019;101(3): 239-49. https://doi.org/10.2106/JBJS.18.00356
  • 24.Brown ML, Javidan P, Early S, et al. Evolving etiologies and rates of revision total knee arthroplasty: a 10-year institutional report. Arthroplasty. 2022;4(1):39. https://doi.org/10.1186/s42836-022-00134-7
  • 25.Büyükdoğan K, Öztürkmen Y, Goker B, et al. Early results of a novel modular knee arthrodesis implant after uncontrolled periprosthetic knee joint infection. BMC Musculoskeletal Disorders. 2023;24(1):889. https://doi.org/10.1186/s12891-023-07016-2

Early and Mid-Term Results of Two Stage Revision Arthroplasty in Infected Total Knee Arthroplasty Cases

Year 2025, Volume: 8 Issue: 1, 19 - 24

Abstract

Abstract
Background: Total knee arthroplasty is a treatment method to relieve pain and limitation of movement caused by many knee diseases such as degenerative arthritis. Our aim was to retrospectively evaluate the early and mid-term results of patients with infected total knee arthroplasty who underwent two-stage revision as a treatment method and to compare them with the literature.
Methods: Patients who were diagnosed with infected knee prosthesis in the Orthopaedics and Traumatology clinic of our hospital between January 2004 and 2014 and decided to undergo two-stage revision as a treatment method were included in this study. Laboratory results, radiographs, American Knee Society clinical and functional scores were evaluated.
Results: Twenty knees of 19 patients were included in the study. The first stage of two-stage revision was performed in all patients and the second stage was performed in 17 patients. Of the 20 knees diagnosed with infected total knee arthroplasty, 3 had early, 6 had delayed, and 11 had late infection. Preoperative clinical score was 53.29 ± 9.51, postoperative 83.21 ± 9.51 (p<0.001); functional score was 40.88 (SD 20.48) preoperatively and 63.23 ± 30.81 (p=0.018) postoperatively. The mean degree of flexion was 68.52° ±19.34 preoperatively and 92.64° ±16.30 after revision (p<0.001). Compared to the pre-revision period, pain levels of all our patients decreased and walking distances increased.
Conclusion: Two-stage revision surgery in infected total knee prostheses was found to be compatible with the literature in terms of eradication of infection, postoperative clinical and functional scores.

References

  • 1.Osmon DR, Berbari EF, Berendt AR, et al. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clinical infectious diseases, 2013;56(1), 1-10. https://doi.org/10.1093/cid/cis966
  • 2.Koh CK, Zeng I, Ravi S, et al.. Periprosthetic joint infection is the main cause of failure for modern knee arthroplasty: an analysis of 11,134 knees. Clinical Orthopaedics and Related Research®. 2017;475(9), 2194-2201. https://doi.org/10.1007/s11999-017-5396-4
  • 3.Thompson O, W-Dahl A, Lindgren V, et al. Similar periprosthetic joint infection rates after and before a national infection control program: a study of 45,438 primary total knee arthroplasties. Acta Orthopaedica. 2021;1-7 https://doi.org/10.1080/17453674.2021.1977532
  • 4.Shahi A, & Parvizi J. Prevention of periprosthetic joint infection. Archives of bone and joint surgery. 2015;3(2), 72. https://doi.org/10.2106/JBJS.KS.M.00062
  • 5.Blanco JF, Diaz A, Melchor FR, et al. Risk factors for periprosthetic joint infection after total knee arthroplasty. Archives of Orthopaedic and Trauma surgery. 2020;140, 239-45. https://doi.org/10.1007/s00402-019-03304-6
  • 6. Jie Chen, Yunying Cui, Xin Li, et al. Risk factors for deep infection after total knee artroplasty: a meta-analysis, Arch Orthop Trauma Surgery. 133;675-687, 2013. https://doi.org/10.1007/s00402-013-1723-8
  • 7.Di Benedetto P, Di Benedetto ED, Buttironi MM, et al. Two-stage revision after total knee arthroplasty. Acta Bio Medica: Atenei Parmensis. 2017;88(Suppl 2), 92.
  • 8.Insall JN, Thompson F M, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. JBJS. 1983;65(8): 1087-98. https://doi.org/10.2106/00004623-198365080-00008
  • 9.Lee K, Goodman SB. Current state and future of joint replacements in the hip and knee. Expert Rev Med Devices 2008; 5: 383-93. https://doi.org/10.1586/17434440.5.3.383
  • 10.Bannister GC. İnfections in hip and knee prosthesis. Current Opinion in Orthop. 1991;2:65.
  • 11.Toossi N, Adeli B, Rasouli MR, et al. Serum white blood cell count and differential do not have a role in the diagnosis of periprosthetic joint infection. J Arthroplasty. 2012;27(8 SUPPL.):51-4. https://doi.org/10.1016/j.arth.2012.03.021
  • 12.Sigmund IK, Puchner SE, Windhager R. Serum inflammatory biomarkers in the diagnosis of periprosthetic joint infections. Biomedicines. 2021; 9(9): 1128. https://doi.org/10.3390/biomedicines9091128
  • 13.Sigmund IK, Dudareva M, Watts D, et al. Limited diagnostic value of serum inflammatory biomarkers in the diagnosis of fracture-related infections. The bone & joint journal. 2020;102(7):904-11. https://doi.org/10.1302/0301-620X.102B7.BJJ-2019-1739.R1
  • 14.Xiong L, Li S, Dai M. Comparison of D-dimer with CRP and ESR for diagnosis of periprosthetic joint infection. Journal of Orthopaedic Surgery and Research. 2019;14: 1-5. https://doi.org/10.1186/s13018-019-1282-y
  • 15.Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. The bone & joint journal. 2013;95(11):1450-2. https://doi.org/10.1302/0301-620X.95B11.33135
  • 16.Trampuz A. Widmer AF. İnfections associated with orthopaedic implants. Curr. Opin. İnfect. Dis. 2016;19:349-56. https://doi.org/10.1097/01.qco.0000235161.85925.e8
  • 17.Zimmerli W. Prosthetic joint associated infections. Best practice and research. 2006;20:1045-63. https://doi.org/10.1016/j.berh.2006.08.003
  • 18.Brause BD. Mandell GL, Bennett JE, et al. Principles and Practice of Infectious Diseases. 7th edn. Philadelphia: Elsevier; 2010. Infections with Prostheses in Bones and Joints; pp. 1469-74.
  • 19.Sönmez MM, Berk A, Ugurlar M. et al. Midterm clinical and radiological outcomes of total knee arthroplasty. Şişli Etfal Hospital Medical Bulletin 2016;50(2):115. https://doi.org/10.5350/SEMB.20160315022015
  • 20.Evans, J. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. The Lancet.2019;393.10172:655-63. https://doi.org/10.1016/S0140-6736(18)32531-5
  • 21.Walker RH. Management of infected total knee arthroplasties. Clin. Orthop. 1994;186:81-9. https://doi.org/10.1097/00003086-198406000-00014
  • 22.Haleem AA. Mid term to long term fallowup of two stage reimplantation for infected knee artrhroplasties. Clin. Orthop. and Related research. 2004;428:35-9. https://doi.org/10.1097/01.blo.0000147713.64235.73
  • 23.Petis SM, Perry KI, Mabry TM, et al. Two-stage exchange protocol for periprosthetic joint infection following total knee arthroplasty in 245 knees without prior treatment for infection. JBJS. 2019;101(3): 239-49. https://doi.org/10.2106/JBJS.18.00356
  • 24.Brown ML, Javidan P, Early S, et al. Evolving etiologies and rates of revision total knee arthroplasty: a 10-year institutional report. Arthroplasty. 2022;4(1):39. https://doi.org/10.1186/s42836-022-00134-7
  • 25.Büyükdoğan K, Öztürkmen Y, Goker B, et al. Early results of a novel modular knee arthrodesis implant after uncontrolled periprosthetic knee joint infection. BMC Musculoskeletal Disorders. 2023;24(1):889. https://doi.org/10.1186/s12891-023-07016-2
There are 25 citations in total.

Details

Primary Language Turkish
Subjects Orthopaedics
Journal Section Articles
Authors

Seda Zor Çakilli 0009-0003-8747-8866

Abdurrahman Örtücü 0000-0002-8243-0703

Edip Bayrak 0000-0001-8641-122X

Dilek Yılmaz 0000-0001-6944-9875

Publication Date
Submission Date November 26, 2024
Acceptance Date March 3, 2025
Published in Issue Year 2025 Volume: 8 Issue: 1

Cite

APA Zor Çakilli, S., Örtücü, A., Bayrak, E., Yılmaz, D. (n.d.). Enfekte Total Diz Artroplastisi Olgularında İki Aşamalı Revizyon Artroplastisinin Erken ve Orta Dönem Sonuçları. Journal of Cukurova Anesthesia and Surgical Sciences, 8(1), 19-24.

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