Abstract
Introduction
47 yrs male patient had a prior history
2005 Fx. proximal tibia (open Fx.)
2007 Metal removal
2008 Arthroscopic debridement (2 times)
He visited out hospital with severe pain and tenderness X-ray (Fig 1) and MRI (Fig 2) findings as follows.
Conclusively, He had a chorinic osteomylitis of proximal tibia with soft tissue absess.
1st Surgery
I did arthroscopic debridement Arthroscopic finding shows synovitis, meniscus tear and chondromalacia. I did meticulous debridement (irrigation & curettage)
2nd Surgery
He did primary total knee arthro-plasty instead of two-stage exchange arthroplasty in may, 2010 at the another hospital
3rd Surgery
After 7 months since he had did total knee arthroplasty, he visited to my hospital again with sudden onset of painful swelling & heating sensation
4th Surgery
I did second stage reimplantation for infected total Knee arthroplasty after 7 weeks. Now he got a pain relief & ROM restroration.
Results
Follow up 12 months X-ray showing all implants to be well-positioned and stable. Clinically, there was no implant considered to be loose
In this study, the knee society and functional scores at final follow up were 82 and 68.
Conclusion
The infection after sequales of open proximal tibia fracture is treated by two-stage exchange total knee arthroplasty instead of primary total knee arthroplasty
Two-stage reimplantation of an infected total knee arthroplasty using a static antibiotic-cement spacer achieved an infection control and improvement in the clinical result 3)
We use an antibiotic-loaded cement spacer(ALACS) preserved knee function between stages, resulting in effective treatment of infection, facilitation of reimplantation, and improved patient satisfaction 1)
The principle surgical technique used for two-stage revision of infected total knee including: (1) exposure, (2) implant removal and debridement, and (3) construction of both static and mobile antibiotic spacers 2
