title: Outcome of total knee replacement following explantation and cemented spacer therapy.
abstract: BACKGROUND
  Infection after total knee replacement (TKR) is one of the serious complications which must be pursued with a very effective therapeutic concept. In most cases this means revision arthroplasty, in which one-setting and two-setting procedures are distinguished. Healing of infection is the conditio sine qua non for re-implantation. This retrospective work presents an assessment of the success rate after a two-setting revision arthroplasty of the knee following periprosthetic infection. It further considers drawing conclusions concerning the optimal timing of re-implantation.
  
  
  METHODS
  A total of 34 patients have been enclosed in this study from September 2005 to December 2013. 35 re-implantations were carried out following explantation of total knee and implantation of cemented spacer. The patient's group comprised of 53% (18) males and 47% (16) females. The average age at re-implantation time was 72.2 years (ranging from 54 to 85 years). We particularly evaluated the microbial spectrum, the interval between explantation and re-implantation, the number of surgeries that were necessary prior to re-implantation as well as the postoperative course.
  
  
  RESULTS
  We reported 31.4% (11) reinfections following re-implantation surgeries. The number of the reinfections declined with increasing time interval between explantation and re-implantation. Patients who developed reinfections were operated on (re-implantation) after an average of 4.47 months. Those patients with uncomplicated course were operated on (re-implantation) after an average of 6.79 months. Nevertheless, we noticed no essential differences in outcome with regard to the number of surgeries carried out prior to re-implantation. Mobile spacers proved better outcome than temporary arthrodesis with intramedullary fixation.
  
  
  CONCLUSIONS
  No uniform strategy of treatment exists after peri-prosthetic infections. In particular, no optimal timing can be stated concerning re-implantation. Our data point out to the fact that a longer time interval between explantation and re-implantation reduces the rate of reinfection. From our point of view, the optimal timing for re-implantation depends on various specific factors and therefore it should be defined individually.
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ghanem
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Zajonz
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Bollmann
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Geissler
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Prietzel
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Moche
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Roth
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Christoph-E
authors.initials: CE
authors.lastname: Heyde
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Josten
keywords: cemented spacer therapy; endoprosthesis infection; periprosthetic infection; total knee replacement