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A novel technique to preserve range of motion in two-stage revision of infected total knee arthroplasty

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Abstract

Purpose

Two-stage revision represents the gold standard in the treatment of infected total knee arthroplasty. Different techniques have been proposed, mostly not preserving range of motion. An articulated antibiotic-loaded cement spacer made in association with two unicompartmental implants has been used as an alternative to a static spacer in an effort to retain as much movement as possible between the stages in young, high-demand patients with preserved ROM.

Methods

We evaluated nine consecutive patients with a mean age of 66.5 years. The second stage was performed after lab tests returned to normal and culture proved negative. Mean follow-up was 4.6 years.

Results

Mean ROM from a preoperative value of 105.6° was 103.5° after the first stage, and improved to 110.0° after the definitive implant. Mean Knee Society score was 27.6 preoperatively improving to 86.4 points postoperatively. WOMAC score showed that six patients were very satisfied with the overall result of their reimplanted knee, three subjects were somewhat satisfied. No recurrence of infection, no significant radiolucent lines or osteolysis were recorded at clinical and radiological follow-up and the patients were satisfied with the outcome.

Conclusions

Results indicated that this technique may ensure the advantages of a static spacer, but allow a greater ROM and better functional recovery. It may be considered as a viable option in selected cases even though the higher costs of two unicompartmental implants should be considered in the light of other aspects, such as prolonged hospital stay and rehabilitation in revision of infected total knee arthroplasty.

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Acknowledgments

The authors state that they have no conflict of interests.

Conflict of interest statement

The authors state that:

- The paper is original and not under publication of other journal in any language

- The clinical protocol was approved by the Local Ethical Committee of the Institution, and all patients gave their informed consent to the procedures and follow-up

- All the authors exclude any form of external or internal funding, having no professional or financial affiliations that may be perceived to have altered the paper and its content

- They all contributed to the ideation, preparation, and writing of the manuscript.

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Authors and Affiliations

  1. Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139, Florence, Italy

    Christian Carulli, Marco Villano, Roberto Civinini, Fabrizio Matassi, Lorenzo Nistri & Massimo Innocenti

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  1. Christian Carulli
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  2. Marco Villano
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  3. Roberto Civinini
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  4. Fabrizio Matassi
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  5. Lorenzo Nistri
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  6. Massimo Innocenti
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Correspondence to Christian Carulli.

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Carulli, C., Villano, M., Civinini, R. et al. A novel technique to preserve range of motion in two-stage revision of infected total knee arthroplasty. International Orthopaedics (SICOT) 37, 1069–1074 (2013). https://doi.org/10.1007/s00264-013-1880-y

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  • DOI: https://doi.org/10.1007/s00264-013-1880-y

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