ABSTRACT
BACKGROUND: There is no uniform standard on whether the patella is replaced in total knee arthroplasty. There are many control studies on patella replacement versus non-replacement, but few studies compare the prognosis of non-replacement patella according to the severity grade of patellofemoral arthritis. OBJECTIVE: To compare the effects of patellofemoral arthritis on prognosis of total knee arthroplasty with patella retention according to the severity of patellofemoral arthritis, METHODS: One hundred and ninety-two cases of total knee arthroplasty who received patella retention with Depuy Synthes prosthesis in the First Affiliated Hospital of Zhengzhou University from January 2016 to January 2017 were retrospectively analyzed, and the follow-up time was more than 2 years. According to the Lwano classification system, the imaging severity of patellofemoral arthritis was graded into mild group (0-I period, n-83) and severe group (phase II—IV, n=109). All patients signed the informed consents and the study was approved by the hospital ethics committee. Clinical prognosis was assessed by Knee Society Score, functional score, Feller score and anterior knee pain score. The imaging prognosis was assessed by patella tilt angle, fit angle, patella displacement distance and patellar ligament ratio. The statistical method of t test was used to analyze the clinical and imaging results before and after surgery. RESULTS AND CONCLUSION: (1) One patient had persistent anterior knee pain, and one patient had wound effusion and secondary healing after debridement. The remaining patients achieved first-stage healing. (2) There were significant differences in the preoperative functional scores and Knee Society Score between mild and severe groups (P 0.05). (3) There was a significant difference between two groups in the patella tilt angle, fit angle and patella displacement distance before surgery (P 0.05). (4) In summary, after at least 2 years of follow-up, the severity of patellofemoral arthritis makes no effect on the clinical and imaging prognosis of patients undergoing total knee arthroplasty with patella retention. Even in patients with severe patellofemoral arthritis, a good prognosis is obtained after total knee arthroplasty with patella retention.
ABSTRACT
BACKGROUND: Compared with revision surgery, debridement antibiotics irrigation and implant retention for treatment of periprosthetic joint infection has the advantages of fewer traumas, shorter time, and lower cost. However, the indications and perioperative management are still controversial. OBJECTIVE: To review the application of preoperative indication, intraoperative operation and postoperative antibiotic application of debridement antibiotics irrigation and implant retention for the periprosthetic joint infection. METHODS: PubMed, Web of Science, Embase, and The Cochrane Library database were retrieved from 2000 to 2018. The key words were “total knee arthroplasty, periprosthetic joint infection, diagnose, treatment”. Chinese literature was searched in the Wanfang database and CNKI from 2000 to 2018, and the keywords were “arthroplasty, postoperative infection, debridement antibiotics irrigation and implant retention”. Relevant literatures were screened, and the success rate of retained prosthesis in the treatment of infection after joint replacement was counted. The most accurate diagnostic criteria and the most effective treatment methods were summarized. RESULTS AND CONCLUSION: At present, there is no unified international standard for the diagnosis of periprosthetic joint infection after joint replacement. Many organizations have put forward some consensus and guidelines. Parvizi et al. proposed new diagnostic criteria for periprosthetic joint infection based on other consensus and guidelines, which is highly sensitive and specific, and has been accepted by most people. Debridement antibiotics irrigation and implant retention is suitable for patients with stable and well-fixed prosthesis, short symptom duration, good soft tissue, and no sinus tract formation. During the operation, the infected necrotic tissue and the suspected infected tissue should be thoroughly removed. The iodine-blood water should be soaked for half an hour; the new gasket should be replaced; and the sterilized towel should be replaced with a new set of surgical tools. According to the results of postoperative culture, sensitive antibiotics were combined and rifampin was taken orally out of hospital for 4 months. Debridement antibiotics irrigation and implant retention is the best method for the treatment of periprosthetic joint infection, and has the advantages of less pain, less cost, high acceptance and avoiding revision.