Abstract
Over the period 1990–2002, 12 patients, 3 male and 9 female, mean age 65 years (58–74), have been treated for deep infection after total knee arthroplasty (TKA). Two patients diagnosed with early and ten with late infection. Diagnosis was clinical, radiological (X-rays, 3 phase bone scan with Tc99m), laboratory (WBC, ESR, CRP) and from knee aspiration cultures. Of the inflammations, three were low grade.
Eight patients had resurfacing total knee replacement, while four hinged type (Endomodel). Five of the initial arthroplasties were referred cases.
Two phase revision was performed to all patients.
Initially there was removal of the prothesis and extensive surgical debridement. Staphylococcus Aureus was cultured from seven arthroplasties, Staphylococcus Epidermidis from three and Pseudomonas Aeruginosa from two.
After the prothesis removal, PMMA spacer with antibiotic was placed, in eleven cases molded to the shape of a TKA which permitted knee motion. A 6–8 week period of IV antibiotic therapy followed, which was based on intraoperative cultures and microbial sensitivity. Finally arthrodesis was performed in two knees, while in the other ten a new cemented TKA was place. All the patients received postsurgery antibiotics for 3–6 months.
No recurrences of infection were note over a follow-up period of 8 months to 10 years, one revision was performed for a fractured femoral stem.
In conclusion, two phase revision arthroplasty is proved to be an invaluable method in the treatment of deep infection after total knee arthroplasty.
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.
