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

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.