Clin Orthop Surg.  2013 Sep;5(3):180-187. 10.4055/cios.2013.5.3.180.

Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer

• Silvestre
• Almeida F
• Renovell P
• Morante E
• Lopez R

• KMID: 1705543
• DOI: http://doi.org/10.4055/cios.2013.5.3.180

Abstract

BACKGROUND
A two-stage revision remains as the "gold standard" treatment for chronically infected total knee arthroplasties.
METHODS
Forty-five septic knee prostheses were revised with a minimum follow-up of 5 years. Static antibiotic-impregnated cement spacers were used in all cases. Intravenous antibiotics according to sensitivity test of the culture were applied during patients' hospital stay. Oral antibiotics were given for another 5 weeks. Second-stage surgery was undertaken after control of infection with normal erythrocyte sedimentation rate and C-reactive protein values. Extensile techniques were used if needed and metallic augments were employed for bone loss in 32 femoral and 29 tibial revisions.
RESULTS
The average interval between the first-stage resection and reimplantation was 4.4 months. Significant improvement was obtained with respect to visual analog scale pain and clinical and functional scores, and infection was eradicated in 95.6% of cases following a two-stage revision total knee arthroplasty. Radiographic evaluation showed suitable alignment without signs of mechanical loosening.
CONCLUSIONS
This technique is a reasonable procedure to eradicate chronic infection in knee arthroplasty and provides proper functional and clinical results. However, it sometimes requires extensile surgical approaches that could imply arduous surgeries. Metallic augments with cementless stems available in most of the knee revision systems are a suitable alternative to handle bone deficiencies, avoiding the use of bone allografts with its complications.

Keyword

Two-stage revision; Chronically infected knee arthroplasty; Extensile approach; Metallic augments

MeSH Terms

Aged
Aged, 80 and over
Anti-Bacterial Agents/*administration & dosage
Arthroplasty, Replacement, Knee/*adverse effects
Female
Humans
Knee Joint/physiology/radiography/surgery
*Knee Prosthesis
Male
Middle Aged
Prosthesis Design
Prosthesis-Related Infections/*therapy
Range of Motion, Articular
Replantation/adverse effects/instrumentation/*methods
Retrospective Studies
Treatment Outcome
Anti-Bacterial Agents

Figure

• 

  Fig. 1 (A) A two-stage revision of a chronically infected knee. Antibiotic-impregnated cement beads acting as static spacer with a short cement stem to minimize cement block migration. (B) In the other images, we can see the knee after revision with a semi-constrained prosthesis with the stems (Performance Avant, Biomet).

• 

  Fig. 2 (A) A revision of multi-operated infected knee with sinus tract. First stage after removing the prosthesis. Static spacer adapted to the defect created. In this case we added Septopal-30 to increase the levels of gentamicin locally. (B) Stability was not achieved with semi-constrained prosthesis, so rotating-hinge prosthesis was employed in this case (RHK, Biomet).

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