ABSTRACT
The results of 24 infected total knee arthroplasties (22 patients) that were treated by irrigation, debridement, and retention of the prosthetic components were prospectively studied. Strict criteria were used for the selection of this method of treatment. Patients had to be less than 30 days after index arthroplasty (postsurgical group) or had to have less than 30 days of knee symptoms (hematogenous group). In addition, there had to be no radiographic signs of osteitis or evidence of a loose prosthetic component. Patients had one to three irrigation and debridement procedures depending on systemic signs, knee symptoms, or the results of knee aspirations. All of the immediate postsurgical infections (10 knees) and 10 of the 14 (71%) late hematogenously infected knees retained the prosthesis without further evidence of infection at the final follow-up visit at 48 months (range, 24-140 months). This study shows that in selected circumstances, irrigation, debridement, and retention of the components can result in low morbidity with high success rates.
Subject(s)
Debridement/methods , Knee Prosthesis/adverse effects , Surgical Wound Infection/therapy , Therapeutic Irrigation/methods , Aged , Aged, 80 and over , Anti-Bacterial Agents , Bacteria/isolation & purification , Bacterial Infections/microbiology , Bacterial Infections/therapy , Combined Modality Therapy , Drug Therapy, Combination/administration & dosage , Drug Therapy, Combination/therapeutic use , Female , Follow-Up Studies , Humans , Infusions, Intravenous , Knee Joint/microbiology , Male , Middle Aged , Prospective Studies , Prosthesis Failure , Radiography , Reoperation , Surgical Wound Infection/diagnostic imaging , Surgical Wound Infection/microbiology , Treatment OutcomeABSTRACT
OBJECTIVE: To study clinical and laboratory factors in patients with systemic lupus erythematosus (SLE) to identify subgroups at extraordinary risk for developing osteonecrosis. METHODS: 31 of 103 (30%) patients with SLE had developed osteonecrosis. Patients were studied to identify clinical characteristics that differentiated patients with and without osteonecrosis. Subjects were studied to determine whether and to what degree factors leading to thrombophilia (anticardiolipin antibodies, aCL) or hypofibrinolysis [lipoprotein(a)] are associated with osteonecrosis. RESULTS: Clinically, the patients with osteonecrosis had significant increases in Cushingoid body habitus, thrombophlebitis, vasculitis, cigarette smoking, and preeclampsia. Highest prednisone dose was positively associated with osteonecrosis. Although IgG aCL were also found to be associated with osteonecrosis, particularly in the white patients with SLE, lipoprotein(a) levels were not increased in either the white or black patients. CONCLUSION: Maximal prednisone doses, changes in body habitus in response to corticosteroid therapy, IgG aCL levels, and clinical evidence of venous thrombosis and vasculitis were associated with osteonecrosis in patients with SLE.
