Two-Stage Reimplantation of Infected Total Knee Arthroplasty with Antibiotic-Loaded Bone Cement Spacer: Comparison of the Types of Antibiotic-Loaded Cement Spacer / 대한정형외과학회잡지

PURPOSE: The treatment results of a two-stage reimplantation of infected total knee arthroplasty with either the articulating or non-articulating types of antibiotic-loaded bone cement spacers were compared and analyzed. MATERIALS AND METHODS: Between July 1995 and October 2005, this study reviewed 29 patients who underwent two-stage reimplantation of infected total knee arthroplasty and were followed up for at least 2 years. Of the 29 cases, 12 used articulating and 17 used the non-articulating type. RESULTS: Fifteen cases (52%) showed bacterial growth in the preoperative and intraoperative bacterial culture, and 14 cases (48%) had no growth. 27 cases showed no evidence of reinfection until the last follow up after two-stage reimplantation. One out of the 12 cases in the articulating group and 1 out of the 17 cases in the non-articulating group had a reinfection. The range of motion (ROM) of the knee joint and HSS knee rating scale increased more significantly in the articulating group than in the non-articulating group, and the degree of increase in the ROM of the knee joint and HSS knee rating scale was significantly larger in the articulating group. CONCLUSION: The two-stage reimplantation with an antibiotic-loaded bone cement spacer showed a 93.1% of success rate. The articulating group showed better results in the knee ROM and HSS knee rating scale than the non-articulating group

Short-term Results of Two-stage Reimplantation Using Antibiotic-loaded Articulating Cement Spacer in Infected Total Knee Arthroplasty

PURPOSE: We reviewed the short-term clinical results of two-stage reimplantation using antibiotic-loaded articulating cement spacer in infected total knee arthroplasty (TKA). MATERIALS AND METHODS: Nineteen consecutive patients (20 knees) with chronic indolent infection after TKA from July, 2004 were treated by two-stage reimplantation using articulating antibiotic spacer and were followed them with a minimum of 18 months. We assessed infecting organism, response of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level following insertion of antibiotic spacer, elapsed time to reimplantation, and duration of parenteral antibiotics therapy. And we also evaluated clinical results using Hospital for Special Surgery (HSS) score, range of motion (ROM) and reinfection rate. RESULTS: The most common was methicillin-resistant staphylococcus epidermidis (8 patients, 53.3%) among the infecting organisms identified in 15 patients. Average ESR and CRP level were 28.9 mm/hr and 3.0 mg/L, each before reimplantation. The elapsed time to reimplantation was 9.7 weeks and the mean duration of parenteral antibiotics was 5.4 weeks. The ROM before spacer insertion was 72.5degrees, increasing to 103.3degrees and HSS score also improved from 47.8 preoperatively to 88.8 without evidence of reinfection at latest follow-up. CONCLUSION: Two-stage reimplantation using articulating antibiotic spacer in infected TKA is thought to be veryeffective surgical option to achieve excellent clinical results through controlling infection and permitting active joint motion.

Comparison of Articular Spacer Versus Static Spacer in the Treatment of Infected Total Knee Arthroplasty

PURPOSE: To compare and analyze the surgical procedure and clinical results of two-stage re-implantation using both articulating and static spacers at infected total knee arthroplasties(TKA). MATERIALS & METHODS: A total of 14 cases were selected for subject of this study in which patients had been diagnosed as infected TKA and had undergone two-stage re-implantation(7 using static spacers and remaining 7 using articulating spacers) from March 1999 to March 2006. RESULTS: In the group using static spacers, ROM improved from 70 degrees in average preoperatively to 98 degrees postoperatively. In the group using articulating spacers, ROM improved from 74 degrees to 105 degrees (p=0.532). HSS score showed an increase from 43 scores in average preoperatively to 81 postoperatively for static spacers and from 41 to 83 for articulating spacers(p=0.780). There was no significant difference in the hour spent for the 1st surgery. The 2nd operation time was shortened to 241 minutes in case of static spacers, and 208 minutes in articulating spacers. One case of relapse was reported with static spacers but none with articulating spacers. CONCLUSION: Two-stage re-implantation of infected TKA using both static and articulating spacers has been found to be effective ways of treatment, requiring, however, long term follow-ups.

Two Stage Revision using Custom Articulating Spacer in an infected TKA: A Novel Method for an Intraoperative Construction of an Articulating Spacer / 대한정형외과학회잡지

PURPOSE: This paper reports a novel technique to create an antibiotic spacer for the treatment of infected total knee replacements (TKA) with surface contours similar to that of the original TKA. MATERIALS AND METHODS: This new technique involved the intra-operative construction of a custom mold made from bone cement along with the removed implant. Twelve consecutive patients treated with this technique were reviewed in the aspect of the degree of flexion, difficulty in exposure at the 2nd stage reimplantation, and complications related to the technique. The functional status was evaluated using the Knee Society score. RESULTS: The degree of flexion was 85 (40-130) preoperatively and 100 (70-110) prior to reimplantation. The postoperative flexion was 112 (90-140) at 6 weeks, 108 (70-140) at 3 months, and 110 (75-140) at 1 year postoperatively. A rectus snip was required in 8 out of 12 cases. Other extensile approaches were not needed. The knee society score was significantly improved from 30/24 to 87/80. No specific complications were noted at the final follow-up. CONCLUSION: This technique allows the immediate stability and mobility after the first stage of reimplantation. This technique offers ease and convenience of surgical technique without considerable increase in surgical cost or time. In addition, it eliminates the requirement for costly commercial mold or special pre-manufactured implants.

Two Stage Reimplantation in Infected Total Knee Arthroplasty Using an Articulating Antibiotics Impregnated Cement Spacer: Surgical Technique

PURPOSE: To evaluate the clinical result of two stage reimplantation of infected total knee arthroplasties, using an antibiotics impregnated articulating cement spacer. MATERIALS AND METHODS: Out of total 7 cases with infected total knee arthroplasties, 4 cases treated with two stage reimplantation, using an antibiotics impregnated articulating cement spacer were included in this study. After the treatment of infected total knee arthroplasties, the treatment of infection was evaluated by physical examination, radiologic studies, and hematologic studies. The results were evaluated using the Hospital for Special Surgery Knee Score (HSS). RESULTS: As results, 4 infected knee cases treated with two stage reimplantation did not have reinfection at the time of the follow up, and physical, laboratory, and radiologic studies were all within normal range. The range of motion of the reimplanted knees were from -5degrees in extension to 130 degrees in flexion, with an average of 117 degrees. The average score of the Hospital for Special Surgery Knee Score was 87. CONCLUSION: In conclusion, two stage arthroplasties, using antibiotics impregnated articulating cement spacer was an effective therapy not only for the treatment of the infection after the total knee arthroplasty but also effectiveness for recovery of the knee function.

Two - Stage Revision of Infected Total Knee Arthroplasty using Antibiotics: Impregnated Cement Spacer

Purpose of the study. The purpose of this study was to evaluate the result of treatment of the infected total knee arthroplasty by two-stage revision. Material. Out of twenty eight total knee arthroplasty revisions, 13 revisions were performed for infected total knee arthroplasties between 1985 and l.996. Two cases of infected total knee arthroplasties were treated by immediate replacement and four cases by arthrodesis. Seven infected total knee arthroplasties had been revised by two-stage revision and followed-up for 38.6 months in average (range, 18-105 months). They were one male and six female patients of 61.6 years old in average. The primary cause of arthroplasty was osteoarthritis in all. Infection was diagnosed by preoperative aspiration, culture of the pus from draining sinus and culture of surgical specimen. Five cases revealed positive growth of causative bacteria, while two were not identified. METHOD: The protocol for two-stage revision began with tbe removal of infected implants and cement. The surrounding bony and soft tissue were thoroughly debrided and cleaned. The dead space between femur and tibia was filled with antibiotics-impregnated cement spacer and beads. Wound was closed and the leg was placed in soft knee brace. Patients received intravenous antibiotic therapy based on culture results for 4-6 weeks. Reimplantation was followed using total condylar prosthesis of posterior stabilizing type in five and semiconstrained type in two cases. RESULT: Two-stage revision was successful in six cases. One case revealed the recurrence of infection eleven months after reimplantation and underwent the repetition of the same two-stage procedure. At the final follow-up, the average Hospital for Special Surgery score was 81.l points, the average Knee Society knee score was 78.6 points and the average functional score was 76.7 points. Patients could regain average 100 degrees of knee flexion. CONCLUSION: The result of two-stage revision for infected total knee arthroplasty was satisfactory, showing that this can be the method of choice for infection treatment and functional restoration. This procedure using antibiotics-impregnated cement spacer and beads can control infection and improve functional results.