Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy.
We present a series of 48 patients with infected total knee replacements managed by the use of articulating cement spacers and short-term parenteral antibiotic therapy in the postoperative period. All patients had microbiological and/or histological confirmation of infection at the first stage of their revision. They all underwent re-implantation and had a mean follow-up of 48.5 months (26 to 85). Infection was successfully eradicated in 42 of the 48 patients (88%). Six had persistent infection which led to recurrence of symptoms and further surgery was successful in eliminating infection in four patients. These rates of success are similar to those of other comparable series. We conclude that protracted courses of intravenous antibiotic treatment may not be necessary in the management of the infected total knee replacement. In addition, we analysed the microbiological, histological and serological results obtained at the time of re-implantation of the definitive prosthesis, but could not identify a single test which alone would accurately predict a successful outcome.
Hart
W J
WJ
The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire SY10 7AG, UK. wjhart@doctors.org.uk
Jones
R S
RS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins; D014640:Vancomycin