title: Long-term outcome of 42 knees with chronic infection after total knee arthroplasty.
abstract: The outcome of treatment in 40 patients (42 knees) with chronic infections after total knee arthroplasty was reviewed. Eighteen knees were treated with a 2-stage reimplantation. Sixteen of these 18 knees were treated with antibiotic-containing beads between debridement and reimplantation, and 7 of these were also treated with antibiotics in the cement at reimplantation. Infection did not recur in any of these 18 knees. Clinically, the 2-stage reimplantation group averaged a score of 90 points on the Knee Society Clinical Rating System. Average function score was 86.5 points, with average range of motion from 2 degrees to 109 degrees. Sixteen knees were treated with an arthrodesis: 9 with a 1-stage technique with a uniplanar external fixator and 7 with a 2-stage technique with intramedullary nail internal fixation. Infection did not recur in 6 of 9 knees treated with the 1-stage technique, but only 2 had a solid arthrodesis. All 7 treated with the 2-stage intramedullary nail technique had no recurrence of infection and achieved a solid fusion. Reimplantation or arthrodesis was not attempted in 8 other knees because of recalcitrant infection, vascular complications, or medical infirmity. Of the 42 knees, 11 (26%) had a severely morbid outcome. The infection could not be eradicated in 7 knees: 6 required amputation and 1 had a solid fusion but chronic drainage. In 3 knees, the infection was cured but resection arthroplasties were required, and in 1 patient an amputation was needed as a result of an intraoperative vascular complication.
authors.affiliation: Department of Orthopaedics, University of Florida College of Medicine, Gainesville, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Bose
authors.forename: P F
authors.initials: PF
authors.lastname: Gearen
authors.forename: J C
authors.initials: JC
authors.lastname: Randall
authors.forename: W
authors.initials: W
authors.lastname: Petty
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods; D001170:Arthritis, Infectious / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016059:Range of Motion, Articular; D012086:Reoperation / Q000379:methods; D013530:Surgical Wound Infection / Q000601:surgery*; D016896:Treatment Outcome