ObjectiveTo investigate the current problems and corresponding solutions regarding the use of antibiotic-impregnated cement spacer for the treatment of periprosthetic joint infection (PJI). MethodsA retrospective analysis was made on the clinical data of 27 patients with PJI who underwent two-stage revision with antibiotic-impregnated cement spacer between January 2001 and January 2013. There were 12 males and 15 females, with an average age of 62.7 years (range, 25-81 years). All arthroplasties were unilateral, including 19 hip PJI and 8 knee PJI. The mean duration from primary arthroplasty to PJI was 25 months (range, 3-252 months). After infection was controlled with the antibiotic-impregnated cement spacer combined with systematic antibiotics treatment, two-stage revision was performed. The effectiveness was evaluated. ResultsOne patient died of myocardial infarction at 2 days after surgery. Infection was controlled, and two-stage revision was successfully performed in 19 patients; deep venous thrombosis occurred in 1 of 3 patients who experienced hip spacer fractures, which was cured after conservative management. The spacers were removed and bacteria-sensitive antibiotics was used because of recurrent infections after the first-stage surgery in 7 patients; 3 patients gave up treatment because infection was not controlled, 4 patients received revision after infection was controlled. Twenty-three patients were followed up 1-5 years (mean, 2.3 years). The average Harris hip score and KSS score at 1 years after revision were significantly improved when compared with preoperative ones (P<0.05). In the 8 patients with gram-negative or fungus infection, 7 were found to have recurrent infection after the first-stage surgery; in the 12 patients with gram-positive infection, no recurrent infection was found. Failed treatment was observed in 1 patient with gram-positive and gram-negative infections and 2 with fungus infection, respectively. ConclusionAntibiotic-impregnated cement spacer has a satisfactory effectiveness for PJI. However, complication of spacer fracture should be noted, especially hip spacers. If the pathogen is gram-negative bacteria or fungus, the implanted spacer may increase the possibility of recurrent infection.
ObjectiveTo investigate the safety and efficiency of intravenous tranexamic acid (TXA) to reduce blood loss in total knee arthroplasty (TKA). MethodsA prospective, randomized, self-controlled study was carried out on 60 patients scheduled for bilateral TKA between January 2012 and December 2013. TXA (10 mg/kg) was injected intravenously approximately 10 minutes before tourniquet release when TKA was performed on one side (TXA group), and TXA was not used on the other side (control group). No significant difference was found in the preoperative hemoglobin (Hgb), platelet (PLT) count, prothrombin time (PT), and activated partial thromboplastin time (APTT) between 2 groups (P>0.05). The amount of drainage, the total blood loss, the hidden blood loss, the postoperative Hgb, the amount of blood transfusion, the ratio of blood transfusion, and the incidence of vein thrombosis embolism (VTE) were compared between 2 groups. ResultsThe amount of drainage and total blood loss were significantly less in the TXA group than in control group (P<0.05), and the Hgb was significantly lower in the control group than in the TXA group at 6 hours, 1, 3, and 7 days after operation (P<0.05). There was no significant difference in the hidden blood loss between 2 groups (t=1.157, P=0.252). The ratio of blood transfusion was significantly less in TXA group (6.7%, 4/60) than in control group (21.7%, 13/60)(P=0.034). The total amount of blood transfusion was 14 units in TXA group, which was significantly less than that of control group (38 units) (P=0.004). Deep vein thrombosis occurred in 3 cases in 2 groups respectively, showing no significant difference (P=1.000). There was no symptomatic pulmonary embolism. All patients were followed up for 8-17 months, with an average of 13.7 months. No new VTE case was found during the follow-up period. ConclusionIntravenous injection of TXA (10 mg/kg) at 10 minutes before tourniquet release in TKA is effective in reducing perioperative blood loss, amount of blood transfusion, and ratio of transfusion, and it will not increase the risk of VTE.