Abstract
Aims
1. A two-stage revision remains as the “gold standard” treatment for chronically infected total knee arthroplaties. 2. Evaluate technical challenges in two stage revision.
Materials and Methods
Fourteen septic knee prostheses were revised with a minimum follow-up of 2 years. Static antibiotic-impregnated cement spacers were used in all cases. Intravenous antibiotics according to sensitivity test of the culture were applied during patients’ hospital stay and continued up to 3 weeks. Oral antibiotics were given for another 3 weeks. Second-stage surgery was undertaken after control of infection with normal erythrocyte sedimentation rate and C-reactive protein values. Extensile techniques were used if needed and metallic augments were employed for bone loss in revision of both femur and tibia components.
Results
The average interval between the first-stage resection and reimplantation was 7 weeks. Significant improvement was obtained with respect to visual analog scale pain and clinical and functional scores, and infection was not seen in all cases following a two-stage revision total knee arthroplasty. Radiographic evaluation showed suitable alignment without signs of mechanical loosening. Average range of movement achieved was 0 to 100 degrees. Most common knee infected was the second knee in bilateral cases.
Conclusions
This technique is a reasonable procedure in chronic infection in knee arthroplasty and provides proper functional and clinical results. However, it sometimes requires extensile surgical approaches that could imply arduous surgeries. Metallic augments with cement less stems available in most of the knee revision systems are a suitable alternative to handle bone deficiencies, avoiding the use of bone allograft with its complications.
