Abstract
Introduction: Infection post knee arthroplasty is a catastrophic surgical complication offering a major challenge to the orthopaedic surgeon. We present the outcome of a two-stage revision implantation technique utilizing a rotational hinge prosthesis with an antibiotic impregnated cement spacer in the interim period.
Materials & Method: Since 1995, 38 definitely infected knee replacements were revised. All were followed prospectively over a 10 year period. Initial treatment consisted of thorough debridement, removal of implants and a period of antibiotic administration. Vancomycin impregnated articulating cement spacer was inserted in the interim. C-reactive protein values were monitored periodically. At second stage all patients were clinically and biochemically free of infection.
Results: Second stage revision was performed at an average interval of 9 months (range 4 – 11 months). Average length of hospital stay post 2nd stage was 19.8 ± 8.2 days. At follow-up (3.5 ± 2.5 years) outcome was poor in 33 % (amputations, arthrodesis, re-infections), good in 49 % (decreased ROM, PFJ pain) and excellent in 13 %. 3, 5% of patients had died with their prostheses in situ. The average pre and post operative Oxford Knee Score were 47.0 ± 7.5 and 21.6 ± 4.3 respectively.
Conclusion: Two-stage re-implantation using a hinge knee prosthesis is a safe and acceptable way of dealing with infected TKRs, conferring a stable reconstruction whilst allowing a through debridement. Thus potentially decreasing failure rates due to recurrence of primary infection. In this challenging group, complication rates were high, but at mid- and long-term review, no prostheses had failed from an aseptic cause. Moreover, this salvage procedure allows a quick rehabilitation and is tolerated well by patients.
Correspondence should be addressed to: Tim Wilton, BASK, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
