Treatment of deep infection of total knee arthroplasty using a two-stage procedure.
OBJECTIVE
Treatment of deep infection of total knee arthroplasty by two-stage reimplantation. Using an articulating spacer may reduce the disadvantages of a static spacer (ligament contracture, muscle atrophy, muscle contraction, arthrofibrosis, and bone loss). Restoration of pain-free loading and ability to walk.


METHODS
Late deep infection after total knee arthroplasty.


BACKGROUND
infection occurring at least 6 weeks after the initial arthroplasty.


METHODS
Large metaphyseal bony defects of the distal femur and proximal tibia. Missing or insufficient extensor mechanism.


METHODS
The articulating spacer is made intraoperatively by cleaning and autoclaving the explanted femoral component and the tibial polyethylene insert. These components are reinserted by "press-fit cementing" without cement interdigitation into the trabecular bone. The cement is loaded with antibiotic during the same operation (2-4 g antibiotics per 40 g of cement powder).


METHODS
With the articulating spacer in place, partial weight bearing with crutches and continuous passive motion daily up to a flexion of 90 degrees are allowed. Usually, reimplantation with a standard revision system is scheduled for 6-12 weeks after spacer implantation.


RESULTS
In a prospective study 33 consecutive patients were treated from February 2000 to July 2003. The average period of hospitalization after spacer implantation was 14 days (8-26 days). Three patients had recurrent infection (success rate 91%) after a mean follow-up period of 28 months (12-48 months). The average Hospital for Special Surgery Knee Score could be increased from 67 points (44-84 points) preoperatively to 87 points (53-97 points) after reimplantation. The complications were one temporary peroneal palsy, one dislocation of the spacer due to the absence of the extensor ligaments, and one fracture of the tibia due to substantial primary metaphyseal bone loss.
Allgemeines und orthopädisches Landeskrankenhaus, Stolzalpe, Osterreich. martin.pietsch@lkh-stolzalpe.at
Martin
M
Pietsch
Siegfried
S
Hofmann
Christian
C
Wenisch
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods; D015992:Body Mass Index; D001843:Bone Cements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors
D000900:Anti-Bacterial Agents; D001843:Bone Cements