Abstract
Knee sepsis following TKR can have devastating consequences for patient as well as surgeon. A two stage revision is a well accepted technique in TKR sepsis with the introduction of a temporary antibiotic cement spacer being the most popular procedure although irrigation techniques are popular in SA.
From a total of 111 revisions TKR from my practice 26 (23%) were 2 stage revisions for joint sepsis following TKR. 3 cases were early, 10 intermediate and 13 late onset sepsis cases. Most common organism was S. Aureus (7/26) and S. Epidermidis (7/26) although numerous other organisms were seen.
In all cases a two stage revision with a Palacos R cements spacer plus parenteral antibiotics were used. Prosthesis used for revision was primary knee prosthesis in 8 cases and revision (stemmed) prosthesis in 18 cases. Follow up range from 13 years to 6 months (average 6.8 years) with only one case of recurrent sepsis (3.8%) which went on to an arthrodesis. Time from debridement and spacer placement to revision TKR varied from 3 weeks to 10 months (average 2.1 months).
This paper shows that meticulous debridement followed by standard antibiotic cement spacer technique with additional parenteral antibiotics is indeed the gold standard approach without necessitating additional irrigation techniques.
Correspondence should be addressed to: Léana Fourie, CEO SAOA, PO Box 12918, Brandhof 9324 South Africa.
