Clinical effects of two-stage joint replacement on septic arthritic knee

Objective: To assess the clinical effect of staged joint replacement for the treatment of septic arthritic knee and the therapeutic differences between antibiotic cement beads and the tibial plateau spacer. Methods: 23 patients (24 knee joints) treated with staged joint replacement for septic arthritis knee were retrospectively reviewed between March 2014 and April 2018. At the first-stage, thoroughly debridement and irrigation with self-made antibiotic cement beads or tibial plateau spacer was performed; After that, systemic antibiotic treatment was followed; when the infection was surely eliminated, second-stage TKA was performed. Knee mobility (range of motion, abbreviated to ROM) and function (HSS scores system) were evaluated before surgery, in the interval period, and after joint replacement. Results: All patients finished follow-up and the mean follow-up time was 27.3 months (12-54 months). Each group has one patient replaced with a homotypic spacer, and all patients eventually cleared the infection. None of the patients had a recurrent infection. The mobility and HSS scores of the two groups were significantly improved post-operation (p<0.05). And there was no significant difference in post-surgery ROM (P=0.153) and the HSS score (P = 0.054) between the two groups. Conclusion: Staged joint replacement is an efficacious way for septic arthritic knees, whether tibial plateau spacer or antibiotic cement beads were used, which can effectively control infection and improve knee function.