Total Knee Arthroplasty: The Efficacy of Calcium Sulfate Beads in One-Stage Aseptic Revision

Iciar M. Dávila Castrodad, J. Ehiorobo, Ethan A. Remily, James Nace, N. Mohamed, N. George, R. Delanois, Wayne A. Wilkie
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Abstract

Background: The risk of periprosthetic joint infection following revision total knee arthroplasty is high, as is the cost of care. Decreasing periprosthetic joint infection risk may include utilization of calcium sulfate beads. Calcium sulfate beads have been gaining momentum in treating infected joints because of their potential advantages, including antibiotic elution and dissolvability. However, literature documenting their utilization in aseptic revision is sparse. This study compares: 1) infection rates; 2) length of stay; 3) subsequent infection procedures; and 4) final surgical outcome between one-stage aseptic revision total knee arthroplasty patients who received calcium sulfate beads and those who did not. Methods: We performed a retrospective chart review to identify patients who underwent aseptic one-stage revision total knee arthroplasty between January 2013 and December 2017. Outcomes collected included postoperative infection rate, length of stay, subsequent irrigation and debridement, and final surgical outcome, classified as a successful total knee arthroplasty reimplantation, a retained antibiotic spacer, or an above knee amputation. Chi-square analysis was used to analyze all categorical variables, while Student’s t-testing was used for continuous variables. A p-value of 0.5 was set as the threshold for statistical significance. Results: Calcium sulfate bead patients did not differ from non-calcium sulfate bead patients with regard to the number of postoperative infections (p=0.103), lengths of stay (p=0.210), irrigation and debridement procedures (p=0.063) and surgical outcome (p=0.085). Conclusion: Patients who received calcium sulfate beads had analogous surgical outcomes and infection rates to non-calcium sulfate bead patients. The use of calcium sulfate beads in aseptic one-stage revision total knee arthroplasty may not be beneficial in preventing infection and reducing costs.
全膝关节置换术:硫酸钙微球在一期无菌翻修中的疗效
背景:翻修型全膝关节置换术后假体周围关节感染的风险高,且护理费用高。降低假体周围关节感染的风险可能包括使用硫酸钙珠。由于其潜在的优势,包括抗生素洗脱和可溶解性,硫酸钙珠在治疗感染关节方面获得了越来越多的动力。然而,文献记录它们在无菌修订中的应用是稀少的。这项研究比较了:1)感染率;2)停留时间;3)后续感染程序;4)接受硫酸钙微球治疗和未接受硫酸钙微球治疗的一期无菌翻修全膝关节置换术患者的最终手术结果。方法:我们对2013年1月至2017年12月期间接受无菌一期全膝关节置换术的患者进行回顾性图表回顾。收集的结果包括术后感染率、住院时间、随后的冲洗和清创,以及最终的手术结果,分类为成功的全膝关节置换术再植入术、保留抗生素间隔物或膝上截肢。所有分类变量采用卡方分析,连续变量采用Student’s -test检验。p值为0.5作为统计显著性的阈值。结果:在术后感染次数(p=0.103)、住院时间(p=0.210)、冲洗和清创程序(p=0.063)和手术结果(p=0.085)方面,硫酸钙珠患者与非硫酸钙珠患者没有差异。结论:接受硫酸钙珠治疗的患者与未接受硫酸钙珠治疗的患者具有相似的手术效果和感染率。在无菌一期翻修全膝关节置换术中使用硫酸钙珠可能不利于预防感染和降低成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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