Abstract
Infection in total knee replacement is a devastating complication. Current literature supports two-stage revision as the gold standard treatment. The alternative single stage procedure has been reported to have favourable results. We assessed the early clinical results of single stage revision for infected total knee replacement.
Between February 2005 and August 2007, 12 patients had revision total knee replacement for infection by the senior authors at two centres. In the majority of the patients, the infective organism was isolated by arthroscopic synovial biopsy prior to revision. Standard single stage procedure included the explantation, debridement and re-implantation of the prosthesis. All the patients received intravenous antibiotics for six weeks and oral antibiotics were continued for further 6 weeks. All the patients had the inflammatory markers monitored during follow-up.
Significant improvement was noted in the SF-12 PCS, WOMAC pain and stiffness scores at the latest follow-up. None of these patients required re-revision. Radiological evaluation was done using the Knee Society system. None of the knees showed evidence of progressive loosening. Radio-opaque lines were found around the stems and were present on immediate post-operative radiographs; this did not indicate loosening or infection at a mean follow-up of two years.
Early clinical and radiological results of the single stage revision for infected total knee replacement appear to be promising. One operation, one anaesthetic and quicker recovery are the advantages for the patient and with the reduced hospital stay it is cost-effective. The problems of stiffness in the knee and muscle wasting with cement spacer are avoided.
Correspondence should be addressed to Editorial Secretary Mr ML Costa or Assistant Editorial Secretary Mr B.J. Ollivere at BOA, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England; Email: mattcosta@hotmail.com or ben@ollivere.co.uk
