Clin Orthop Surg.  2015 Sep;7(3):310-317. 10.4055/cios.2015.7.3.310.

Two-Stage Revision for Infected Total Knee Arthroplasty: Based on Autoclaving the Recycled Femoral Component and Intraoperative Molding Using Antibiotic-Impregnated Cement on the Tibial Side

• Lee BJ
• Kyung HS
• Yoon SD

• KMID: 2234084
• DOI: http://doi.org/10.4055/cios.2015.7.3.310

Abstract

BACKGROUND
The purpose of this study was to determine the degree of infection control and postoperative function for new articulating metal-on-cement spacer.
METHODS
A retrospective study of 19 patients (20 cases), who underwent a two-stage revision arthroplasty using mobile cement prosthesis, were followed for a minimum of 2 years. This series consisted of 16 women and 3 men, having an overall mean age of 71 years. During the first stage of revision, the femoral implant and all the adherent cement was removed, after which it was autoclaved before replacement. The tibial component was removed and a doughy state, antibiotic-impregnated cement was inserted on the tibial side. To achieve joint congruency, intraoperative molding was performed by flexing and extending the knee joint. Each patient was evaluated clinically and radiologically. The clinical assessments included range of motion, and the patients were scored as per the Hospital for Special Surgery (HSS) and Knee Society (KS) criteria.
RESULTS
The mean range of knee joint motion was 70degrees prior to the first stage operation and 72degrees prior to the second stage revision arthroplasty; following revision arthroplasty, it was 113degrees at the final follow-up. The mean HSS score and KS knee and function scores were 86, 82, and 54, respectively, at the final follow-up. The success rate in terms of infection eradication was 95% (19/20 knees). No patient experienced soft tissue contracture requiring a quadriceps snip.
CONCLUSIONS
This novel technique provides excellent radiological and clinical outcomes. It offers a high surface area of antibiotic-impregnated cement, a good range of motion between first and second stage revision surgery for the treatment of chronic infection after total knee arthroplasty, and is of a reasonable cost.

Keyword

Articulating spacer; Metal-on-cement; Infection; Total knee arthroplasty; Two-stage revision

MeSH Terms

Aged
Anti-Bacterial Agents/*administration & dosage/*therapeutic use
Arthroplasty, Replacement, Knee/*adverse effects/*instrumentation/methods
Bone Cements/*therapeutic use
Female
Humans
Male
Middle Aged
Prosthesis-Related Infections/*surgery
Range of Motion, Articular/physiology
Reoperation/*instrumentation/methods
Retrospective Studies
Treatment Outcome
Anti-Bacterial Agents
Bone Cements

Figure

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  Fig. 1 Anteroposterior (A) and lateral (B) radiographs before implant removal.

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  Fig. 2 (A) The removed femoral implant was autoclaved, and the antibiotic-impregnated cement was applied to the recycled implant. (B) The recycled femoral implant with cement was replaced to the femoral condyle. (C) The implant was removed during hardening of the cement. (D) Antibiotic-impregnated cement was inserted in a dough-state after removal of the tibial implant. (E) To achieve joint congruency, intraoperative molding was performed by flexing and extending the knee joint with distal traction.

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  Fig. 3 Immediate postoperative anteroposterior (A) and lateral (B) radiographs showing an autoclaved femoral component and intraoperatively molded antibiotic-impregnated cement. Also, beads were inserted in the intramedullary canal.

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  Fig. 4 Range of motion before reimplantation: 5° extension (A) and 100° flexion (B).

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  Fig. 5 Immediate postoperative anteroposterior (A) and lateral (B) radiographs after revision arthroplasty.

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