, Volume 470, Issue 1, pp 236-243
Date: 27 Sep 2011

Reinfected Revised TKA Resolves With an Aggressive Protocol and Antibiotic Infusion

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Topic
Knee

Abstract

Background

Revision of failed two-stage revision TKA for infection is challenging, and amputation often is the only alternative.

Questions/purposes

We asked whether reinfection after two-stage revision for infection could be controlled with an aggressive revision protocol and intraarticular antibiotic infusion.

Methods

We retrospectively reviewed 18 patients (12 women, six men) who underwent revision for failed reimplantation between January 1999 and January 2008. Mean time from revision for infection to rerevision for reinfection was 5 months (range, 1–18 months). All knees were treated with an individualized protocol that included aggressive exposure, extensive débridement, uncemented components, closure with muscle flaps (seven knees) and other plastic surgery procedures (three knees), and direct antibiotic infusion through Hickman catheters for 6 weeks. Ten knees had one-stage revision; five had débridement, cement spacer, and revision surgery 3 to 4 months later; and three had extensive soft tissue reconstruction before revision surgery. The minimum followup was 2.3 years (mean, 6.1 years; range, 2.3–12.0 years).

Results

The mean Knee Society scores improved from 33 preoperatively to 76. Seventeen of the 18 had control of infection and achieved durable fixation and a closed wound. One patient had recurrent infection 13 months after one-stage revision, was revised, and remained asymptomatic 28 months postoperatively after redébridement and vancomycin infusion for 6 weeks. In one patient, soft tissue closure was not obtained and the patient required amputation.

Conclusions

Extensile exposure, débridement, and soft tissue flaps for closure combined with uncemented fixation of revision implants and antibiotic infusion into the knee controlled reinfection after revision TKA.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at the Missouri Bone and Joint Center, Missouri Bone and Joint Research Foundation, St Louis, MO, USA.