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Two-stage total infected knee arthroplasty treatment with articulating cement spacer

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The treatment of infected total knee arthroplasty (TKA) is controversial and various. Two-stage prolonged reimplantation and 6-week systemic antibiotics use have been a gold standard of treatment in recent years.

Patients

Seventeen knees of 17 patients, who underwent primary TKA and subsequently developed infections, were implanted articulating antibiotic-loaded cement spacer through two-stage reimplantation. In the postoperative period, parenteral antibiotic treatment targeting the specific microorganism detected in each patient was started and continued with oral administration. The mean total (parenteral and oral) antibiotic treatment time was 6.8 weeks (6–10). The spacer remained in its location until complete soft tissue recovery and normal values for laboratory parameters were achieved. The mean time interval between spacer implantation and reimplantation was 4.2 months (3–6).

Results

In the last follow-up examinations of the patients, conditions requiring reoperation were detected in 3 patients (17.6%). In 2 of these patients (11.7%), infection developed after a mean 1-year interval. The joint motion ranges of the patients were measured in the preoperative period, during spacer use, and following reimplantation. The mean joint motion range of the patients was 58º (12–90) in the preoperative period; in the presence of spacer between the two stages, 69º (15–100); and in the last follow-up examination after reimplantation, 95º (10–120).

Conclusion

Use of articulating cement spacer in the treatment of infected TKA is efficient and reliable.

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References

  1. Insall JN, Hood RW, Flawn LB, Sullivan DJ (1983) The total condylar knee prosthesis in gonarthrosis: a five to nine-year follow-up of the first one hundred consecutive replacements. J Bone Jt Surg 65:619–628

    CAS  Google Scholar 

  2. Cuckler JM, Star AM, Alavi A, Noto RB (1991) Diagnosis and management of the infected total joint arthroplasty. Orthop Clin North Am 22:523–530

    CAS  PubMed  Google Scholar 

  3. Rand JA, Fitzgerald RH Jr (1989) Diagnosis and management of the infected total knee arthroplasty. Orthop Clin North Am 20:201–210

    CAS  PubMed  Google Scholar 

  4. Hartman MB, Fehring TK, Jordan L, Norton HJ (1991) Periprosthetic knee sepsis: the role of irrigation and debridement. Clin Orthop Relat Res 273:113–118

    PubMed  Google Scholar 

  5. Schoifet JD, Morrey BF (1990) Treatment of infection after total knee arthroplasty by debridement with retention of the components. J Bone Jt Surg Am 72:1383–1390

    CAS  Google Scholar 

  6. Freeman MA, Sudlow RA, Casewell MW, Radcliff SS (1985) The management of infected total knee replacements. J Bone Jt Surg Br 67:764–768

    CAS  Google Scholar 

  7. Goksan SB, Freeman MA (1992) One-stage reimplantation for infected total knee arthroplasty. J Bone Jt Surg Br 74:78–82

    CAS  Google Scholar 

  8. Morrey BF, Westholm F, Schoifet S, Rand JA, Bryan RS (1989) Longterm results of various treatment options for infected total knee arthroplasty. Clin Orthop Relat Res 248:120–128

    PubMed  Google Scholar 

  9. Teeny SM, Dorr L, Murata G, Conaty P (1990) Treatment of infected total knee arthroplasty: irrigation and debridement versus two-stage reimplantation. J Arthroplasty 5:35–39

    Article  CAS  PubMed  Google Scholar 

  10. Wilde AH, Ruth JT (1988) Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop Relat Res 236:23–35

    PubMed  Google Scholar 

  11. Pitto RP, Spika IA (2004) Antibiotic-loaded bone cement spacers in two-stage management of infected total knee arthroplasty. Int Orthop 28:129–133

    Article  CAS  PubMed  Google Scholar 

  12. Booth RE Jr, Lotke PA (1989) The results of spacer block technique in revision of infected total knee arthroplasty. Clin Orthop Relat Res 248:57–60

    PubMed  Google Scholar 

  13. Fehring TK, Odum S, Calton TF, Mason JB (2000) Articulating versus static spacers in revision total knee arthroplasty for sepsis. Clin Orthop Relat Res 380:9–16

    Article  PubMed  Google Scholar 

  14. Haddad FS, Masri BA, Campbell D, McGraw RW, Beauchamp CP, Duncan CP (2000) The PROSTALAC functional spacer in two-stage revision for infected knee replacements. J Bone Jt Surg Br 82:807–812

    Article  CAS  Google Scholar 

  15. Hofmann AA, Goldberg T, Tanner AM, Kurtin SM (2005) Treatment of infected knee arthroplasty using an articulating spacer. Clin Orthop Relat Res 430:125–131

    Article  PubMed  Google Scholar 

  16. Masri BA, Kendall RW, Duncan CP, Beauchamp CP, McGraw RW, Bora B (1994) Two-stage exchange arthroplasty using a functional antibiotic-loaded spacer in the treatment of the infected knee replacement: the Vancouver experience. Semin Arthroplasty 5:122–136

    CAS  PubMed  Google Scholar 

  17. Sener N, Asik M, Tozun IR, Saglam N (1998) Infekte total diz artroplastisinde debridman + antibiyotik supresyonu. Acta Orthop Traumatol Turc 32(5):408–410

    Google Scholar 

  18. Sener N, Tozun IR, Ozger H (1998) Infekte total diz artroplastisi vakalarımıza yaklasimimiz. Acta Orthop Traumatol Turc 32(1):51–56

    Google Scholar 

  19. Emerson RH Jr, Muncie M, Tarbox TR, Higgins LL (2002) Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res 404:132–138

    Article  PubMed  Google Scholar 

  20. Whiteside LA (1994) Treatment of infected total knee arthroplasty. Clin Orthop Relat Res 299:169–172

    PubMed  Google Scholar 

  21. Rorabeck CH (2002) Session IV: salvage of the infected total knee replacement. Infection: the problem. Clin Orthop Relat Res 404:113–115

    Article  PubMed  Google Scholar 

  22. Walker RH, Schurman DJ (1984) Management of infected total knee arthroplasties. Clin Orthop Relat Res 186:81–89

    PubMed  Google Scholar 

  23. Hofmann AA, Kane KR, Tkach TK, Plaster RL, Camargo MP (1995) Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop Relat Res 321:45–54

    PubMed  Google Scholar 

  24. McPherson EJ, Lewonoswski K, Dorr LD (1995) Techniques in arthroplasty: use of an articulated PMMA spacer in the infected total knee arthroplasty. J Arthroplasty 10:87–89

    Article  CAS  PubMed  Google Scholar 

  25. Meek RM, Masri BA, Dunlop D, Garbuz DS, Greidanus NV, McGraw R, Duncan CP (2003) Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer. J Bone Jt Surg Am 85:1888–1892

    Google Scholar 

  26. Scott IR, Stockley I, Getty CJM (1993) Exchange arthroplasty for infected knee replacements: a new two-stage method. J Bone Jt Surg Br 75:28–31

    CAS  Google Scholar 

  27. Ha C-W (2006) A technique for intraoperative construction of antibiotic spacers. Clin Orthop Relat Res 445:204–209

    PubMed  Google Scholar 

  28. Duncan CP, Beauchamp C (1993) A temporary antibiotic loaded joint replacement system for management of complex infections involving the hip. Orthop Clin North Am 24:751–759

    CAS  PubMed  Google Scholar 

  29. Abdul-Karim FW, McGinnis MG, Kraay M, Emancipator SN, Goldberg V (1998) Frozen section biopsy assessment for the presence of polymorphonuclear leukocytes in patients undergoing revision of arthroplasties. Mod Pathol 11:427–431

    CAS  PubMed  Google Scholar 

  30. Goldman RT, Scuderi GR, Insall JN (1996) Two-stage reimplantation for infected total knee replacement. Clin Orthop Relat Res 331:118–124

    Article  PubMed  Google Scholar 

  31. Haleem AA, Berry JD, Hanssen AD (2004) Mid-term to long-term follow-up of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res 428:35–39

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. 3rd Orthopaedics and Traumatology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Tirebolu Sokak, 27/18, Yukariayranci, 06550, Ankara, Turkey

    Ali Ocguder & Murat Bozkurt

  2. Orthopaedics and Traumatology Clinic, Siirt State Hospital, Siirt, Turkey

    Ahmet Firat

  3. Orthopaedics and Traumatology Clinic, Golbasi State Hospital, Ankara, Turkey

    Osman Tecimel

  4. 2nd Orthopaedics and Traumatology Clinic, Ataturk Training and Research Hospital, Ankara, Turkey

    Sukru Solak

Authors
  1. Ali Ocguder
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  2. Ahmet Firat
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  3. Osman Tecimel
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  4. Sukru Solak
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  5. Murat Bozkurt
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Correspondence to Murat Bozkurt.

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Ocguder, A., Firat, A., Tecimel, O. et al. Two-stage total infected knee arthroplasty treatment with articulating cement spacer. Arch Orthop Trauma Surg 130, 719–725 (2010). https://doi.org/10.1007/s00402-010-1054-y

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  • DOI: https://doi.org/10.1007/s00402-010-1054-y

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