[Experience in the treatment of infections of the total knee arthroplasty.].
This retrospective study evaluates medium-term results of a two-phase treatment of infections of total knee arthroplasty. In the period of 1990-1997 thirty-three infected total knee replacements were treated (once bilaterally) in 32 patients (21 females and 11 males). In 20 cases the basic diagnosis was osteoarthritis and in 13 cases rheumatoid arthritis. The results were evaluated in the interval of 34-82 months after the revision surgery.The success of the therapy was evaluated on the basis of the fulfilment of the following criteria: a functional implant, the period of post-operative follow-up longer than 24 months, the patient subjectively without complaints, good local conditions, laboratory tests tending to the normalization of the values of the sedimentation of erythrocytes and C-reactive protein, radiograph without progression of radioluscent lines, at least 3 months without antibiotics. The success rate of the two-phase revision surgery after the infection of the total knee replacement in the whole group of patients was 72,7 %, due to the additional therapy it increased up to 78,8 % and in patients with osteoarthritis even to 85 %. In rheumatoid arthritis the efficiency of the procedure was substantially lower and reached only 69,2 %. A serious therapeutic problem is posed by the infections caused by streptococci mainly due to their ability to recur. The simplest and least costly of the laboratory methods for the diagnosis and monitoring of the efficiency of the therapy proved to be the regular monitoring of the dynamics of changes in the sedimentation of erythrocytes, also in patients with rheumatoid arthritis. Decisive factors for the success is a timely removal of the infected implant, repeated careful debridement of infected tissues, a sufficiently long interval between individual phases and a longterm targeted antibiotic therapy. Key words: infection of total knee arthroplasty, a twophase therapy of the infection, revision surgery of the total knee arthroplasty.
Vavrík
P
P
I. ortopedická klinika 1. LF UK Praha a FN Motol, Praha.
Landor
I
I
Jahoda
D
D