Two-stage reimplantation without cement spacer for septic total knee replacement.
OBJECTIVE
The management of an infected total knee implant is a major challenge to the orthopedic surgeon. We report the outcome using two-stage reimplantation without cement spacers between stages.


METHODS
Seven infected total knee replacements (TKR) were treated with the two-stage reimplantation technique from September 1994 through January 2001. Treatment of these patients consisted of thorough debridement and removal of the implants. No antibiotic-impregnated cement blocks or beads were inserted and only a long leg cylinder cast was applied for immobilization between stages. Intravenous antibiotics were used and C-reactive protein (CRP) values were monitored. All of the patients were free of infection and revision TKR was performed without using antibiotic-impregnated cement for fixation at an average interval of 6.3 weeks (range 6-10 weeks).


RESULTS
The average length of follow-up was 3.5 years (range 1-7 years) and the average HSS (Hospital for Special Surgery) knee score was 86 points (range 78-94). A good result was obtained in one patient and excellent results in six patients. Average range of motion was 91 degrees (range 80 degrees -100 degrees ). No recurrence of infection was noted.


CONCLUSIONS
Two-stage reimplantation without using a cement spacer between stages for septic total knee replacement is tolerable for patients, simpler for surgeons and can achieve good results without recurrence of infection.
Jhao
Chie- Ming
C
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Jiang
Ching-Chuan
CC
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002097:C-Reactive Protein / Q000032:analysis; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein