Experience of Revision Operation for Infected Total Knee Arthroplasty

ABSTRACT

PURPOSE: The purpose was to report the results of revision by two or more than three times operation using antibiotics impregnated cement block for the treatment of deep infection after total knee arthroplasty. MATERIALS AND METHODS: Between June 1999 and October 2001, 6 patients were reviewed retrospectively, who were treated for deep infection after total knee arthroplasty. At the time of reimplantation, the average age was 67 years. The average follow-up period was 26.7 months. Two coagulase-negative Staphylococcus aureus infections and one methicillin resistant Staphylococcus aureus infection were found on culture study. In three cases, group I, antibiotics impregnated cement block was inserted at the first operation. And then reimplantation was performed at 2nd operation as two-stage reimplantation. In another three cases, group II, debridement was done without removal of implant at the first operation. All three cases were failed to control infection. The infection was controlled and reimplantation was done at 4th time operation. The results were assessed according to the knee rating system of the Hospital for Special Surgery (HSS). Recurrence of infection or development of any other complication was evaluated. RESULTS: The average range of knee motion was 88 degrees at the time of diagnosis of deep infection, and it was 92 degrees at final follow-up. The average range of motion was 107 degrees in group I and 77 degrees in group II. Functional knee score of the HSS was improved from 69 points preoperatively to 88 points postoperatively. Each mean HSS score was 93 points in group I and 81 point in group II. There were no recurrence of infection during follow-up period after reimplantation. CONCLUSION: When the diagnosis of deep infection is confirmed in total knee arthroplasty, removal of the implants, thorough debridement and insertion of antibiotics impregnated bone cement blocks at the first operation is apparently better than only debridement without removal of implant. And two-stage reimplantation is better results in preserving knee joint function.