Total diz protezi revizyonu erken dönem sonuçları
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Date
2001
Authors
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Publisher
Uludağ Üniversitesi
Abstract
Kasım 1996 - Nisan 1999 tarihleri arasında 16 olguya total diz protezi (TDP) revizyonu ygulandı. Olguların 13'ü kadın (%8 1), 3'ü erkek (%19) olup ortalama yaş 65 (43-80) ve ortalama takip süresi 22,6 ay (12-41) idi. 12 'si septik (%75), 4 'ü aseptik (%25) gevşeme bulguları nedeniyle opere edilen olgulardan septik gevşemesi olanlara iki, aseptik gevşemesi olanlarda ise tek aşamalı revizyon cerrahisi uygulandı tek aşamalı revizyon cerrahisi yapılan olgularda ilk ameliyatta protezin kırılması, debridman sonrası antibiyotikli çimento uygulaması ile eklem aralığı korundu. Tüm olgulardan derin doku kültürleri alındı. 12 (%75) septik olgunun 10 'unda (%81) kültürlerde üreme tespit edildi. Septik olguların tümüne ortalama 28 gün (21-40) parenteral, 34 gün (28-42) oral antibiyotik tedavisi uygulandı. Klinik olarak inflamasyon bulgularının tamamen düzelmesi, CRP ve sedimantasyon değerlerinin normal sınırlara inmesi sonucunda revizyon TDP uygulandı. Olguların eklem çizgisi, fibula dış çıkıntı ile femur protez distali arası mesafe ölçülerek değerlendirildi. Bu mesafe revizyon öncesi ortalama 31.5 mm iken, revizyon ameliyatı sonrası ortalama 40.5 mm, femur medial epikondil-femur protez distali arası mesafe ise ameliyat öncesi ve ameliyat sonrası rası ile 23 mm ve 24 mm olarak bulundu. 0lguların ameliyat öncesi diz puanı 46, 3 (31-62), fonksiyonel puanı 34,3 (10-50) olup, ameliyat sonrası diz puanı 84,3 (55- 90), fonksiyonel puan 75 (60-90) idi. Ameliyat öncesi ve sonrası elde edilen diz ve fonksiyonel puanlar istatistiksel olarak karşılaştırıldığında anlamlı farklılık tespit edildi (p<0.001). Ameliyat sonrası 3 (%18) olguda cilt nekrozu, 1 (%16) olguda serebral emboli sonucu oluştuğu düşünülen şuur bulanıklığı , 1 (%6) olguda pseudo anevrizma, 1 (%6) olguda patella kimliği tespit edildi. Primer TDP uygulaması sonrası gelişen enfeksiyonun tedavisinde 2 aşamalı revizyon cerrahisinin etkin yöntem olduğu, eklem çizgisinin anatomik yapıya uygun olarak restorasyonunun klinik sonuçları olumlu yönde etkileyeceği kanısındayız.
Total knee arthroplasty was performed on 16 patients in our clinic between November 1996-April_ 1999. Of 16 patients, 13 were female (81%), 3 were male (19%) and mean age was 65 years (43-80) and average follow-up period was 22.6 months (12-41). Due to losing in 12 (75%) septic cases two stage revision surgery was performed and 4 (2 5%) aseptic cases underwent one stage procedure. In cases of two stage procedure, the first step was to remove prosthesis, to carry out debridement and to apply bone cement with antibiotic to retain joint space. Deep tissue cultures were taken from all cases. Cultures were positive in 10 cases (81%) out of 12 (75%) septic cases. All of the septic cases were given parenteral antibiotic therapy 28 days (21-40) on average and oral antibiotic therapy 34 days (28-42) on average. Asa result of the definitive improvement in inflammation, decreases in CRP and reduced the sedimentation rate to normal level, revision prosthesis was implanted.The joint lines of the cases was evaluated by measuring the distance between the lateral part of the fıbula and distal part of the prosthesis. While this distance was meanly 31.5 mm bejare revision, it was 40.5 mm after the revision operation The distance between distal part of the prosthesis and medial epicondyle of the femur was 23 mm preoperatively and 24 mm postoperatively. Preoperative mean knee score was 46.3 (31-62) mean fonetianal s score was 34.3 (10-50) and their mean post-ap knee score was 84.3 (75-90), mean function score was 75 (60-90). Signifıcant difference was established when pre-op and post-ap knee and functional scores were compared (p<0.001). Posloperalive complications were skin necrosis in 3(18%) cases, confusion thought to have resulted from cerebral embolism in I (6%) case, pseudoaneurysm in I case (6%), pate/lar fractures in I case (6%).
Total knee arthroplasty was performed on 16 patients in our clinic between November 1996-April_ 1999. Of 16 patients, 13 were female (81%), 3 were male (19%) and mean age was 65 years (43-80) and average follow-up period was 22.6 months (12-41). Due to losing in 12 (75%) septic cases two stage revision surgery was performed and 4 (2 5%) aseptic cases underwent one stage procedure. In cases of two stage procedure, the first step was to remove prosthesis, to carry out debridement and to apply bone cement with antibiotic to retain joint space. Deep tissue cultures were taken from all cases. Cultures were positive in 10 cases (81%) out of 12 (75%) septic cases. All of the septic cases were given parenteral antibiotic therapy 28 days (21-40) on average and oral antibiotic therapy 34 days (28-42) on average. Asa result of the definitive improvement in inflammation, decreases in CRP and reduced the sedimentation rate to normal level, revision prosthesis was implanted.The joint lines of the cases was evaluated by measuring the distance between the lateral part of the fıbula and distal part of the prosthesis. While this distance was meanly 31.5 mm bejare revision, it was 40.5 mm after the revision operation The distance between distal part of the prosthesis and medial epicondyle of the femur was 23 mm preoperatively and 24 mm postoperatively. Preoperative mean knee score was 46.3 (31-62) mean fonetianal s score was 34.3 (10-50) and their mean post-ap knee score was 84.3 (75-90), mean function score was 75 (60-90). Signifıcant difference was established when pre-op and post-ap knee and functional scores were compared (p<0.001). Posloperalive complications were skin necrosis in 3(18%) cases, confusion thought to have resulted from cerebral embolism in I (6%) case, pseudoaneurysm in I case (6%), pate/lar fractures in I case (6%).
Description
Keywords
Revizyon total diz artroplastisi, İki aşamalı uygulama, Revision totul knee arthroplasty, Two-stage procedure
Citation
Bilgen, Ö. F. vd. (2001). ''Total diz protezi revizyonu erken dönem sonuçları''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 27(1-2-3), 27-31.