Management of Infected Total Knee Arthroplasty / 대한정형외과학회잡지

ABSTRACT

A total of 15 revision total knee arthroplasties in infected cases had been followed for an average 31.4 moths(ranging between 1 year 4 months and 10 years) from 1983 to 1992 at Kyung Hee University Hospital. Average age of the patients was 60 years old (ranging between 27 and 80 years). Of the total 15 infected total knee arthroplasties, original diagnosis was osteoarthritis in 11 patients, rheumat,oid arthritis in three patients, and tuberculosis in one patient. In nine of 15 patients, causative orgamisms were not found. But such clinical evidences as increased erythrocyte sedimentation rate, draining sinus, local heating, intraoperative findings, and pathologic findings demonstrated the infection of total knee arthroplasty. In 15 cases, seven cases were early infection and eight were late infection. Two cases of tuberculosis were diagnosed with intraoperative pathology. The majority of prosthetic loosening was found on the tibial side. Several methods of treatment were applied to the infected cases. One-stage or two-stage reimplantation were used in seven cases, knee fusion in six cases, and conservative treatment was used in two cases. Average period from initial total knee arthroplasty to prosthesis removal of fusion is 20. 3 months(ranging between 11 months and 64 months). In cases of two stage reimplantation, antibiotic-mixed bone cement was implanted after removal of prosthesis to increase the local concentration of antibiotics. The average interval from prosthesis removal to revision in 4 cases of two stage reimplantation was 9.9 weeks(ranging between 43 days and 122 days). All patients were evaluated according to the knee rating Scale of Hospital for Special Surgery. Prior to revision operation in 7 reimplantation cases, the average knee score was 50.1 points, and the average range of motion was 70°. After revision, the average knee score was 81. 1 points. The average range of motion was 98°. Complete union was obtained in all cases of knee fusion. Even though at the time of follow up there has been no recurrence of infection after revision or fusion, long term follow up is needed. Interrmittent knee joint swelling and pus drainage were observed in conservatively treated cases.