14. SOME EXPERIENCES WITH TWO-STAGE ARTHROPLASTY IN PATIENTS WITH JOINT-DESTROYING INFECTION
Main Article Content
Abstract
Purpose: Joint-Destroying Infection (JDI) is a severe stage of Septic Arthritis (SA), due to many causes such as primary joint infection, after joint surgery...The patient eventually becomes disabled because of rapid cartilage destruction due to infection, joint adhesion fusion, loss of function, pain and persistent pus leakage. This is a challenge for orthopedic surgeons. Two-stage arthroplasty has become the gold standard in the surgical treatment of patients with infectious joint destruction. This study, through surgery on 24 patients with joint destruction infections, aims to: - Describe the clinical characteristics and causes of joint destruction leading to the decision to have a 2-stage joint replacement - Evaluate preliminary results, state some initial experiences in surgery for this complex lesion.
Materials and methods: Prospective study, 24 cases of joint destruction infection indicated for 2-stage arthroplasty, at Quy Hoa Hospital, conducted from 2017 to 2023. Indications for surgery are based on disease selection, determining the cause of infectious joint destruction according to clinical, X-ray (and MRI), purulent fluid culture, blood biochemical test and cell cultures. Results were evaluated according to Modified Harris Hip Score standards for hip joint, Knee Function Score for knee joint and the improvement infection. The earliest follow-up period is 1 year, the longest is 6 years. Process data according to SPSS 20.0.
Result: 24 patients (13 hips and 11 knees) with infected joint destruction underwent 2-stage surgery. The average follow-up time was 32.2 months. After surgery, both clinical and functional outcomes were significantly improved. The overall success rate of the two-stage technique is 87.5%. There were no serious complications or deaths during or after the 2-stage surgery. The most commonly identified pathogen is staphylococcus and most cultures do not grow bacteria. The cause of joint infection is often complications after surgery (osteosynthesis, joint replacement, arthroscopy): 62,5% or corticosteroid injections.
Conclude: Two-stage arthroplasty surgery for patients with infected joint destruction is a difficult, heavy surgery that requires patience and is unlikely to be successful. The above results have contributed to proving that this is an effective method to treat irreversible joint destruction due to infection, improve joint function, ultimately improve the patient's quality of life.
Article Details
Keywords
Two-stage arthroplasty surgery, Joint-Destroying Infection (JDI), Revision - Periprosthetic Joint Infection (PJI), Revision- Aseptic (RA), Septic Arthritis (SA)
References
factors for subsequent diagnosis of prosthetic
joint infection. Infect Control Hosp Epidemiol.
2010;31(3):298.
[2] Culliford D, Maskell J. Future projections of total hip and knee arthroplasty in the UK: results
from the UK Clinical Practice Research Datalink. Osteoarthritis Cartilage. 2015; 23:594–600.
[3] Chen C.E., Wang J.W., Juhn R.J. Total hip arthroplasty for primary septic arthritis of the hip
in adults. Int Orthop. 2008;32(5):573.
[4] Diwanji S.R., Kong I.K., Park Y.H., Cho S.G.,
Song E.K., Yoon T.R. Two-stage reconstruction of infected hip joints. J Arthroplasty.
2008;23(5):656.
[5] Fleck E.E., Spangehl M.J. An articulating antibiotic spacer controls infection and improves pain
and function in a degenerative septic hip. Clin
Orthop Relat Res. 2011;469(11):3055.
[6] Donatto K.C. Orthopedic management of
septic arthritis. Rheum Dis Clin North Am.
1998;24(2):275.
[7] Ford A.N., Holzmeister A.M., Rees H.W., Belich
P.D. Characterization of outcomes of 2-stage exchange arthroplasty in the treatment of prosthetic joint infections. J Arthroplasty. 2018;33(7S):
S224.
[8] Jupiter J.B., Karchmer A.W., Lowell J.D., Harris W.H. Total hip arthroplasty in the treatment
of adult hips with current or quiescent sepsis. J
Bone Joint Surg Am. 1981;63(2):194.
[9] Kennedy N., Chambers S.T., Nolan I. Native joint
septic arthritis: epidemiology, clinical features,
and microbiological causes in a New Zealand
population. J Rheumatol. 2015;42(12):2392.
[10] Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave
A, Mont MA. Periprosthetic joint infection. Lancet. 2016; 387:386–394.
[11] Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD, Inform Team Re-infection outcomes
following one- and two-stage surgical revision of
infected hip prosthesis: a systematic review and
meta-analysis. PLoS One. 2015;10: e 0139166.
[12] Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk
factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J. 2017;14: 529–536.
[13] Lenguerrand E, Whitehouse MR, Beswick AD,
Jones SA, Porter ML, Blom AW. Revision for
prosthetic joint infection following hip arthroplasty: evidence from the National Joint Registry. Bone Joint Res. 2017; 6:391–398.
[14] Matthews PC, Berendt AR, McNally MA, Byren
I. Diagnosis and management of prosthetic joint
infection. BMJ. 2009; 338: b1773.
[15] Weston V.C., Jones A.C., Bradbury N., Fawthrop
F., Doherty M. Clinical features and outcome of
septic arthritis in a single UK Health District
1982-1991. Ann Rheum Dis. 1999;58(4):214.
[16] Mortazavi S.M., Vegari D., Ho A., Zmistowski B., Parvizi J. Two-stage exchange arthroplasty for infected total knee arthroplasty:
predictors of failure. Clin Orthop Relat Res.
2011;469(11):3049.
[17] Moore AJ, Blom AW, Gooberman-Hill R. Deep
prosthetic joint infection: a qualitative study of
the impact on patients and their experiences of
revision surgery. BMJ Open. 2015; 009495.
[18] Nagra N.S., Hamilton T.W., Ganatra S., Murray D.W., Pandit H. One-stage versus two-stage
exchange arthroplasty for infected total knee
arthroplasty: a systematic review. Knee Surg
Sports Traumatol Arthrosc. 2016;24(10):3106.
[19] Parvizi J, Fassihi SC, Enayatollahi MA. Diagnosis of periprosthetic joint infection following hip
and knee arthroplasty. Orthop Clin North Am.
2016; 47:505–515.
[20] Papanna M.C., Chebbout R., Buckley S., Stockley I., Hamer A. Infection and failure rates following total hip arthroplasty for septic arthritis:
a case-controlled study. Hip Int. 2018;28(1):63.
[21] Ross J.J. Septic arthritis. Infect Dis Clin North
Am. 2005;19(4):799.
[22] Rafiq I, Gambhir AK, Wroblewski BM, Kay PR.
The microbiology of infected hip arthroplasty.
Int Orthop. 2006; 30:532–535.
[23] Sharff K.A., Richards E.P., Townes J.M. Clinical
management of septic arthritis. Curr Rheumatol
Rep. 2013;15(6):332.
[24] Shaikh A.A., Ha C.W, Park Y.B. Two-stage
approach to primary TKA in infected arthritic knees using intraoperatively molded articulating cement spacers. Clin Orthop Relat Res.
2014;472(7):2201.
[25] Tande A.J., Patel R. Prosthetic joint infection.
Clin Microbiol Rev. 2014;27(2):302.