The evaluation and initial management of arthritis

Short-interval two-stage approach to primary total knee arthroplasty for acutely septic osteoarthritic knees

Treatment strategies for advanced knee osteoarthritis with coexistent joint infection are not well established. While in periprosthetic joint infection the two-stage approach has been studied extensively, only few case reports on two-stage total knee arthroplasty (TKA) for knee osteoarthritis with coexistent joint infection have been published. The purpose of this paper was to report on our method of implementing a two-stage TKA with intervening antibiotic-loaded articulating cement spacers and a short interval between first- and second-stage procedures to treat two patients with Staphylococcus aureus-infected end-stage knee osteoarthritis. Consistent infection eradication was found at a 1-year follow-up with postoperative range of motion and knee scores comparing favourably with those of other case series. Level of evidence V.

Two-Stage Primary Total Knee Arthroplasty with Well-Designed Antibiotic-Laden Cement Spacer Block for Infected Osteoarthritic Knees: The First Case Series from China

OBJECTIVE

We aimed to assess the efficacy of applying a two-stage primary total knee arthroplasty (TKA) with an antibiotic-laden cement spacer block to treat infected osteoarthritic knees.

METHODS

This retrospective study included 17 cases of severely infected osteoarthritic knees treated with two-stage primary TKA. Open debridement and irrigation with insertion of a well-designed antibiotic cement spacer was performed as the first stage. Systemic antibiotics were used in the interval period. Two-stage TKAs were performed after elimination of infection. The pre- and post-operative Hospital for Special Surgery Knee (HSS) score as well as range of motion (ROM) were assessed.

RESULTS

Elimination of infection was achieved in 16 patients. C-reactive protein returned to normal levels in an average of 3.4 wks (range, 1-7 wks), whereas erythrocyte sedimentation rate (ESR) recovered in an average of 11.4 wks (range, 6-19 wks). The average interval between the two-stage operations was 16.8 wks (range, 10-27 wks). Compared with the pre-operative level, the mean HSS score had a substantial increase after the first-stage and second-stage surgery (p<0.05). The post-operative maximum extension degree was smaller and the maximum flexion and ROM degree were larger than the pre-operative degree (all p<0.05). There were no recurrent infections and no patients lost to follow-up. One patient chose to receive arthrodesis because of uncontrolled infection after numerous operations and treatments.

CONCLUSIONS

Two-stage TKA with open debridement, irrigation, and insertion of a well-designed antibiotic-laden cement spacer at the first stage could provide effective pain relief and function restoration as well as infection control in the interval. This treatment protocol provided an encouraging final clinical outcome, which could be a reliable alternative for patients with infected osteoarthritic knees.

Successful joint arthroplasty after treatment of destructive MRSA arthritis of the knee using antibiotic-loaded hydroxyapatite blocks: a case report

Methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis is frequently associated with a poor clinical outcome. Joint reconstruction may be worth attempting in patients with a history of persistent MRSA infection. Here we report an unusual case of MRSA septic arthritis of the knee joint that was treated successfully by joint replacement after initial placement of antibiotic-loaded hydroxyapatite (HA) blocks.

Cystic masses of the knee: magnetic resonance imaging findings

Cystic masses of the knee comprise a diverse group of pathologic entities ranging from simple cysts to complications of underlying disease to tumors. Although their presentations may be similar, the appropriate treatment and patient management can differ greatly. In this article, we review radiographic and magnetic resonance imaging characteristics of both common and uncommon cystic masses of the knee.

A two-stage approach to primary knee arthroplasty in the infected arthritic knee

Fourteen patients with either septic knee arthritis or osteomyelitis of the knee with marked joint destruction were treated by resection arthroplasty with the introduction of an antibiotic cement spacer block, appropriate antibiotic therapy, and subsequent primary total knee arthroplasty. Most patients with septic arthritis had chronic infection. Eight patients had positive cultures preoperatively; the remaining patients had either a culture negative purulent aspiration or diagnostic radiographic studies. All patients underwent reconstruction with primary total knee arthroplasty on an average of 3.1 months after the initial stage procedure. Knee Society scores progressed from 46 preoperatively to 89 postoperatively, with an average range of motion from 3 degrees to 105 degrees. At latest clinical follow-up (average, 4.5 years), no patients had recurrence of infection. These data suggest that this method is successful in treating chronically infected knees with a 2-staged arthroplasty.

Evaluation and management of occupational low back disorders

This clinical practice review of occupational low back disorders describes work-related risk factors, occupational history, physical evaluation, clinical tests, diagnosis, care, and prevention. It is part of a quality assurance (QA) and quality improvement (QI) effort to establish exemplary occupational practice standards. It emphasizes the involvement of occupational medicine physicians in exposure assessment, care of injured workers, and disease prevention. Important occupational risk factors such as lifting, awkward body posture and vibration, in addition to psychosocial, socio-economic and other factors are summarized. The focus is on mechanical back disorders. Return-to-work, rehabilitation and prevention strategies are discussed as part of integrated disability management involving the injured worker, the primary care provider, employers and other relevant parties.