Use of Antibiotic Eluting Calcium Sulfate Beads in High-Risk Primary Total Knee Arthroplasty.

IF 1.6 4区 医学 Q3 ORTHOPEDICS
Lisa Su, Jeannie Park, Yifan V Mao, Murray T Wong, Matt V Dipane, Adam Sassoon
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Abstract

Local delivery of high-dose antibiotics via absorbable calcium sulfate beads has been investigated as a treatment of prosthetic joint infection (PJI). We investigate this strategy as a prophylactic measure for high-risk patients undergoing primary total knee arthroplasty (TKA). A retrospective review of a single-surgeon consecutive series of primary TKA patients with identified risk factors for PJI development was performed. These patients were treated with calcium sulfate beads containing 1 g of vancomycin and 1.2 g of tobramycin per 10 cc, with 10 cc placed intraarticularly. Outcomes included PJI, wound complications, revision surgery, and medical complications. There were 114 knees in 103 patients, with 76 women (66.7%), a mean age of 66.8 years (range: 21-91), and a mean follow-up of 16 months (range: 3-55). The mean preoperative lifetime PJI risk based on the 2018 International Consensus Meeting on the PJI calculator was 11.3% (standard deviation: 16.3%, range: 0.9-94.3%). Risk factors included medical comorbidities, homelessness, chronic urinary tract infection, other PJI or septic arthritis history, or prior ipsilateral knee surgeries. One delayed PJI occurred 1 year postoperatively from presumed hematogenous seeding following dialysis. There were no other known deep infections. There were nine patients who had delayed wound healing with marginal skin necrosis-six resolved with wound care and three underwent superficial extraarticular surgical debridement. There was one patient who underwent aseptic revision for patellar instability and nine patients required manipulation under anesthesia for stiffness. There was one patient who died after readmission for cardiac arrhythmia and one patient had bilateral DVT. No cases of chronic PJI, persistent wound drainage, or postoperative hypercalcemia were identified. Prophylactic use of antibiotic-eluting calcium sulfate beads in primary TKA has resulted in low rates of early PJI in a high-risk cohort, warranting further prospective studies and investigation.

抗生素洗脱硫酸钙珠在高危原发性全膝关节置换术中的应用。
通过可吸收硫酸钙珠局部递送大剂量抗生素作为治疗假体关节感染(PJI)的研究。我们研究这种策略作为高危患者接受原发性全膝关节置换术(TKA)的预防措施。回顾性回顾了一个单一外科医生连续系列的原发性TKA患者,确定了PJI发展的危险因素。这些患者使用硫酸钙珠治疗,每10毫升含1克万古霉素和1.2克妥布霉素,10毫升置于关节内。结果包括PJI、伤口并发症、翻修手术和医学并发症。103例患者114个膝关节,女性76例(66.7%),平均年龄66.8岁(范围:21-91),平均随访16个月(范围:3-55)。基于PJI计算器2018年国际共识会议的平均术前终身PJI风险为11.3%(标准差:16.3%,范围:0.9-94.3%)。危险因素包括医疗合并症、无家可归、慢性尿路感染、其他PJI或脓毒性关节炎史或既往同侧膝关节手术。一例迟发性PJI发生在术后1年,原因是透析后假定有血液播散。没有其他已知的深度感染。有9例患者因边缘皮肤坏死而延迟伤口愈合,其中6例通过伤口护理解决,3例进行了关节外浅表手术清创。有1例患者因髌骨不稳接受无菌修复,9例患者因僵硬需要麻醉下操作。1例患者因心律失常再入院后死亡,1例患者双侧深静脉血栓形成。未发现慢性PJI、持续性伤口引流或术后高钙血症病例。在高危队列中,预防性使用抗生素洗脱硫酸钙珠治疗原发性TKA导致早期PJI发生率较低,值得进一步的前瞻性研究和调查。
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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来源期刊
CiteScore
4.50
自引率
5.90%
发文量
139
期刊介绍: The Journal of Knee Surgery covers a range of issues relating to the orthopaedic techniques of arthroscopy, arthroplasty, and reconstructive surgery of the knee joint. In addition to original peer-review articles, this periodical provides details on emerging surgical techniques, as well as reviews and special focus sections. Topics of interest include cruciate ligament repair and reconstruction, bone grafting, cartilage regeneration, and magnetic resonance imaging.
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