全髋及全膝置换术后感染的治疗概论

To discuss the management of infections around total knee and hip arthroplasties.Methods and Results:We present the results of our management of 521 patients with infection around total hip arthroplasty and 262 with infected total knee arthroplasty between 1970 and 2001.131 of the hips and 94 of the knees were managed conservatively.Nine total knees and 11 total hips with infection were managed by soft tissue debridement and irrigation without removing the arthroplasty.Two of the knees and 3 of the hips were well cured of their infection while 5 from each group had a fair result.Seventeen patients had their knee arthroplasties exchanged in one stage.Nine were confirmed infected,4 were well cured.Fifty were revised in two stages of whom 37 were well cleared.Fort three had hip revision in one stage for infection,of whom 31 were well healed and 198 were revised in two stages with 128 well cured.Seventy-seven of the total knees were managed by arthrodesis.One hundred and froty-two patients were managed with an excision arthrophasty of the hip.Seventy one were cured at first attempt and another 18 after two attempts.Eight patients required limb ablation.Five of these above the knee and three through the hip .four patients died in this series(3 hip and 1 knee arthroplasty),Three had serious vascular complications(2 hip and 1 knee arthroplasty).Conclusion:Low grade musculo skeletal infection presents little or no threat to health,let alone life in the majority of cases,A single operation has some obvious advantages,The costs are halved and the period of hospitalisation or recumbency is halved for knees and reduced to one third for hips.The less ovious advantages of one stage exchanges of knees are the greatly reduced incidence of wound morbidity and in both hips and knees there is a lower incidence of thrombo-embolic disease-a potentially fatal complication.Naturally post-operative rehabilitation will be expedited.The most important advantage of a two stage programme is better chance of curing infection.It may take longer to rehabilitate after a two stage programme but at the end of the day there is little difference in the final level of pain and function between one and two stage exchanges of hips and knees.Among the advantages of a two stage propramme is the fact that one has not burnt one‘s bridges because if the operation fails to bring the infection under control one can either repeat the debridement or switch to arthrodesis in the case of a failed knee arthroplasty or leave the hip as an excision arthroplasty.

Overall Management of Infections around Total Knee and Hip Arthroplasties

Objective:To discuss the management of infections around total knee and hip arthroplasties.Methods and Results:We present the results of our management of 521 patients with infection around total hip arthroplasty and 262 with infected total knee arthroplasty between 1970 and 2001.131 of the hips and 94 of the knees were managed conservatively.Nine total knees and 11 total hips with infection were managed by soft tissue debridement and irrigation without removing the arthroplasty.Two of the knees and 3 of the hips were well cured of their infection while 5 from each group had a fair result.Seventeen patients had their knee arthroplasties exchanged in one stage.Nine were confirmed infected,4 were well cured.Fifty were revised in two stages of whom 37 were well cleared.Forth three had hip revision in one stage for infection,of whom 31 were well healed and 198 were revised in two stages with 128 well cured.Seventy seven of the total knees were managed by arthrodesis.One hundred and forty two patients were managed with an excision arthroplasty of the hip.Seventy one were cured at first attempt and another 18 after two attempts.Eight patients required limb ablation.Five of these above the knee and three through the hip.Four patients died in this series (3 hip and 1 knee arthroplasty).Three had serious vascular complications (2 hip and 1 knee arthroplasty).Conclusion:Low grade musculo skeletal infection presents little or no threat to health,let alone life in the majority of cases.A single operation has some obvious advantages.The costs are halved and the period of hospitalisation or recumbency is halved for knees and reduced to one third for hips.The less obvious advantages of one stage exchanges of knees are the greatly reduced incidence of wound morbidity and in both hips and knees there is a lower incidence of thrombo embolic disease-a potentially fatal complication.Naturally post operative rehabilitation will be expedited.The most important advantage of a two stage programme is better chance of curing infection.It may take longer to rehabilitate after a two stage programme but at the end of the day there is little difference in the final level of pain and function between one and two stage exchanges of hips and knees.Among the advantages of a two stage programme is the fact that one has not burnt one's bridges because if the operation fails to bring the infection under control one can either repeat the debridement or switch to arthrodesis in the case of a failed knee arthroplasty or leave the hip as an excision arthroplasty.