S30 TWO-STAGE REIMPLANTATION WITH APPLICATIONSPACER FOR ANTIBIOTICS IN SEPTIC TOTAL ARTHROPLASTY

Abstract

The management of a bacterial periprosthetic infection by two-stage re-implantation should be presented using an implanted application spacer for antibiotics to maintain mobility and soft tissue balance and ensure simultaneous local delivery of antibiotics. Indication is an acute periprosthetic infection, acute and chronic course of the infection with unknown spectrum of organism, hardly to treat and with a probable loss of mobility due to protracted immobilization after implant removal. Acute infections with a known spectrum of organisms that can be controlled by synovectomy and antibiotic treatment or by one-stage re-implantation are contraindications for this treatment. Spacers are available for hip and knee replacements including surface replacements of the knee. First a complete synovectomy is performed; the implant bed is then prepared for implantation of the application spacer for antibiotics. Silicone catheters are advanced through two separate drill holes into the intramedullary canal and then inserted into the perforated implant stems. Daily parenteral doses of antibiotics in parenteral doses are delivered through the percutaneous silicone catheters directly into the intramedullary canal. The application spacer for antibiotics allows daily physiotherapy and even mobilization on a CPM device. Partial weight bearing may even be allowed, if there is sufficient stability. Once the CRP values have decreased to normal levels, the definitive implant is placed using antibiotic-impregnated cement according to current resistance studies. 36 patients have been treated with this method since 1993. Two-stage re-implantation of a total knee was performed in 20 cases, and re-implantation of a total hip in 16 cases. The longest postoperative follow-up period is now 10 years. Till now, no revision surgery has been required on a joint treated in this manner, and no periprosthetic re-infections have been observed. In the knee, a range of motion of 0/0 /106 degrees was achieved after an average follow-up period of 6.1 years. In the hip, values of 10/0/110 degrees were achieved after an average of 6.3 years. Revision surgery for infection included cases of fungal and tubercular infection. A postoperative Hospital for Special Surgery rating of 79.5 was achieved in the knee and a rating of 81.3 in the Harris hip score.