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

ABSTRACT

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.