Soins de santé : avis actuels

Abstrait

Review of Clinical and Functional Outcome of Prosthetic Salvage for Infected Total Knee Replacement

Janipireddy SB

We have retrospectively studied the infected total knee replacement cases treated by open irrigation and debridement from 1996 to 2006 at NHS Tayside hospitals. Case notes of 18 (17 patients) were reviewed and looked into factors such as criteria chosen for surgery, timing of debridement, organism cultured and antibiotic duration. A success rate of 94% was noted (only 1 case of failure). Failure of the procedure included those which were re-infected or underwent some other treatment after initial debridement. The clinical and functional outcome amongst the successful cases was noted to be good as evidenced by knee society scores. The median follow-up was 3 years. The commonest organism found was staphylococcus aureus (27%). The single case of failure was a 77 year old female with no significant co-morbidities and had mixed organisms in culture. No relation was found between success and failure with regard to age, sex, pre-operative diagnosis and co-morbidity. However, timing of surgery and the length of antibiotic administration were considered relevant to the success of this method. Despite the hesitant and not so encouraging results of some previous studies concerning prosthetic salvage by this method, we believe that this procedure has a role in immediate post-operative period in carefully chosen cases within 4 weeks of index surgery.