RESUMO
Infection in total knee replacement is a rare but devastating complication. The current literature tends to support a two-stage revision as definitive treatment of established deep infection. Despite the fact that single stage revision is a well recognised treatment for the infected hip replacement, it has not gained the same level of support in the knee. This article reviews the literature of two-stage and single stage revision and reports the senior author's experience with the latter.
Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Falha de Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Humanos , Articulação do Joelho/microbiologia , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Infecções Relacionadas à Prótese/microbiologia , Radiografia , ReoperaçãoRESUMO
Stem dissociation in modular revision knee arthroplasty, due to failure of the frictional lock of the Morse taper, has previously been reported in the literature. The medium-term to long-term implications of stem dissociation are however unknown because the clinical outcomes have not been reported. We report a series of 10 cases of tibial-stem dissociation in the Coordinate revision knee system (DePuy, Warsaw, Ind). At an average follow-up of 8.1 years (range, 6-11 years), there was no detriment to the clinical outcome in 9 cases in which there was a contained bony defect. In one case in which there was a significant medial-tibial uncontained bony defect, there was a failure of the prosthesis, which necessitated re-revision arthroplasty surgery at 4 years. We therefore question whether long canal-filling tibial stems are necessary in all revision knee arthroplasties, particularly when there is a contained bone defect together with optimal alignment and adequate support of the prosthesis, and a non-constrained-polyethylene insert is used.
