[Therapy of bacterial knee joint infection by radical synovectomy and implantation of a cemented stabilized knee joint endoprosthesis].
BACKGROUND
The report presents an alternative to the treatment of joint destruction in cases of knee joint empyema by resection or arthrodesis: implantation of a stabilised knee prosthesis using antibiotic-loaded bone cement for fixation.


METHODS
From 1985 to 1997 a total of 33 knees in 32 patients (21 female, 12 male) were treated for knee empyema by radical synovectomy and implantation of a stabilised knee prosthesis fixed in position with antibiotic-loaded bone cement. The antibiotics were chosen according to the antibiogram of the pathogen. In all these cases the infections had not responded to previous treatment. The criterion for success was the elimination of infection. The follow-up period ranged from 2 to 15 years.


RESULTS
Of 33 infected knees 31 (93.9%) were followed up. In 22 cases (71.0%) the infection was eliminated by primary surgery. In five cases (16.1%) further exchange operations were necessary to eliminate the infection. In four cases (12.9%) preservation of the joint was not possible.


CONCLUSIONS
Uncontrolled infection in cases of knee empyema and destruction of the joint can be treated by radical synovectomy and implantation of a stabilised knee prosthesis using antibiotic-loaded bone cement for fixation. The success rate corresponds to the results of one-stage exchange arthroplasty to treat periprosthetic infection of knee prostheses. This therapy should be performed only in specialised centres which have the facilities and personnel essential for accurate bacteriological diagnosis and recommendation.
Siegel
A
A
Endo-Klinik, Hamburg.
Frommelt
L
L
Runde
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements; D004653:Empyema / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008768:Methylmethacrylates / Q000008:administration & dosage*; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000601:surgery*; D000074402:Synovectomy; D013585:Synovitis / Q000601:surgery*
D001843:Bone Cements; D005839:Gentamicins; D008768:Methylmethacrylates; C030159:gentamicin-polymethylmethacrylate bead