J Korean Orthop Assoc.  2014 Apr;49(2):133-139. 10.4055/jkoa.2014.49.2.133.

A Two-Stage Approach to Primary Total Knee Arthroplasty in Recurrent Septic Arthritis

• Sohn OJ
• Lee DC
• Lee SJ
• Moon JJ
• Son WS

• KMID: 2185218
• DOI: http://doi.org/10.4055/jkoa.2014.49.2.133

Abstract

PURPOSE
The purpose of this study is to evaluate the usefulness of a two-stage approach to primary knee arthroplasty with recurrent septic arthritis.
MATERIALS AND METHODS
We studied 22 patients with recurrent septic arthritis, and we observed them for more than one year of follow-up survey from January 2005 to April 2012 at Yeungnam University Medical Center. The clinical assessment was performed following Knee Society knee score, Knee Society function score, and International Knee Documentation Committee Score (IKDC) subjective assessment. In addition, we analyzed the causative organisms, significant medical comorbidities (diabetes mellitus), period up to primary knee arthroplasty, and radiologic assessment with reference to disease prognosis.
RESULTS
The average range of postoperative knee motion showed a good result, with an average of 115degrees. Knee Society knee score improved from 23.5 to 81.0, and Knee Society function score also increased from 22.5 to 73.2. Subjective assessment by IKDC was divided into 15 normal patients and 7 nearly normal patients. No significant difference was observed between patients with causative organisms and those with diabetes mellitus. In the final follow-up survey, recurrence of infection was not reported.
CONCLUSION
A two-stage approach to primary knee arthroplasty with recurrent septic arthritis is a useful method, because it showed good clinical and radiologic results and favorable subjective assessment.

Keyword

septic knee; recurrent; total knee arthroplasty

MeSH Terms

Academic Medical Centers
Arthritis, Infectious*
Arthroplasty*
Comorbidity
Diabetes Mellitus
Follow-Up Studies
Humans
Knee*
Prognosis
Recurrence

Figure

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  Figure 1 Intraoperative photograph (debridement of synovium and infected tissue).

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  Figure 2 Intraoperative photograph. (A) Bone cutting on distal femur and proximal tibia. (B) Insertion of an antibiotic-impregnated cement spacer block and beads.

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  Figure 3 Change of the Knee Society knee score and function score.

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  Figure 4 Postoperative Knee Society knee score and function score according to the causative organism. MRSA, Methicillin resistant Staphylococcus aureus.

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  Figure 5 Postoperative clinical outcomes according to the underlying disease (diabetes mellitus).

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