Abstract
Purpose: The results of infected total knee arthroplasty management are studied, in order to evaluate the effectiveness of our treatment protocol, which is based on clinical manifestations of the infection.
Material: 22 infected total knee arthoplasty were studied (9 of them had been send from other hospitals).
Method: According to the clinical manifestations of the infection, patients were treated with one of the following methods: In the first group, 7 patients with primary postoperative infection (within the first 3 weeks after the operation) and with no MRSA pathogen, were treated with surgical debridement, keeping off the wound drainage for a long period and with antibiotic administration for 6–12 weeks. In the second group, 10 patients with late onset of infection or primary infection with MRSA pathogen or acute hematogenic infection with loose implant, were treated with wide surgical debridment, removal of all the materials and revision surgery after a 2–3 months period of antibiotic administration. In the third group, 3 patients with acute hematogenic infection but stable implants 2 to 6 years postoperatively, were treated with meticulous surgical debridement, exchange of polyethylene and administration of antibiotics for a long period. In the fourth group, 2 very old patients with bad general condition, were treated only with antibiotics.
Results: In the first group there is full eradication of the infection and there is no indication of recurrence (F.U 2–6 years). In the second group 8 patients had their infection fully eradicated and 2 patients recurrended 6 and 8 months postoperatively. One underwent arthrodesis and the other is still receiving antibiotics under pathologist directions. In both patients there was a great amount of bone absorption and soft tissue necrosis around the implant. For patients of the third group complete eradication was achieved. Finally, for the 2 patients of the forth group, periods of exacerbation and remission of the infection exist, with good and poor quality of life, respectively.
Conclusions: The treatment protocol that we apply was based on the clinical manifestations of the infection and was successful in most cases. Bone absorption, tissue necrosis and microorganism resistance are bad prognostic factors.
The abstracts were prepared by Eleni Koutsoukou. Correspondence should be addressed to him at the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST), 20, A. Fleming str, 15123 Marousi, Athens, Greece.
