Řešení infekce náhrady kolenního kloubuu pacientů s revmatoidní artritidou

The Approaches to Infection of KneeProstheses Joint in Patients with Rheumatoid Arthritis

To control deep infections of prostheses of the knee joint several procedures are suggested.Antibiotic treatment, debridement and lavage, resection arthroplasty, one-stage, two-stage reim-plantation, arthrodesis and finally amputation. The method of choice is two-stage reimplantationusing spacer embedded in cement. The spacer serves prevention of excessive contraction of softtissues, supports the extremity, permits partial loading, improves bone quality and promotesantibiotic release. At the First Orthopaedic Clinic of the First Faculty Hospital of Charles University12 patients with rheumatoid arthritis were treated where infection of a knee joint prosthesisoccurred between 1990 – 1997. A total of 13 knee joints were involved, as in one female patient theinfection was bilateral. The successfulness of two-stage reimplantation was 69.2 %. The mean flexionof the knee joint after reimplantation is 94 degrees. This confirms that restriction of mobility bya spacer and orthesis does not significantly affect the function of the knee joint. The mean followup period is 4.3 years. In two cases the spacer had to be used twice. In one instance without success.Arthrodesis was used twice during revision of the spacers as the final solution. In one instancearthrodesis was used to resolve repeated infection after reimplantation of the knee joint. In onefemale patient the arthrodesis did not heal. In patients with rheumatoid arthritis the Coventry IIItype of infection prevails, i.e. late haematogenic infection, in 54 %. This fact prompts the necessityof intensive treatment of all intercurrent infections diseases as well as preventive antibiotictreatment to avoid all serious infections.

Key words:
RA, total knee prosthesis, complications, infection, spacer