抗菌薬含有骨セメントを用いた膝関節感染の治療成績

抄録

Objective: For the treatment of infected total knee arthroplasty (TKA) and pyogenic arthritis, radical debridement is essential. According to the recent successful results of two-stage reimplantation for the infected TKA using antibiotic-loaded acrylic cement (ALAC) spacer, its antibiotic delivery effect is demonstrated. So that may have an effectiveness as an additional treatment more than closed irrigation and so on. We discussed about clinical results of ALAC attachment for the treatment of pyogenic arthritis and infected TKA.

Methods: Five infected total knee arthroplasty whose diagnosis were all rheumatoid arthritis and three pyogenic arthritis treated between 2013 and 2018 were analyzed. The infecting organisms included methicillin-sensitive staphylococcus aureus (MSSA) in four cases, methicillin-resistant staphylococcus aureus (MRSA) in three cases and streptococcus equisimilis in one case. All cases were followed for more than one year and studied about eradicating of infection.

Results: Three of five infected TKA were successful in eradicating after operation, which included one MRSA case. Remaining two cases resulted in two-stage reimplantation following the removal of prostheses. In three pyogenic arthritis, one case was successful in eradicating after operation. One case was eradicated by repeated surgery, and remaining one case has resulted in prolonged infection.

Conclusion: Our experience suggests that radical debridement and attachment of ALAC could 50% of eradication for infected knee including infected TKA and pyogenic arthritis. The result of this treatment is not so excellent but technically simple, and we have future perspective of the improvement considering about the antibiotic concentration of ALAC.