Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer

Chi-Shiung Hsu, Chia-Chen Hsu, Jun-Wen Wang, Po-Chun Lin
Chang Gung Medical Journal 2008, 31 (6): 583-91

BACKGROUND: Static antibiotic-impregnated cement spacers have been used widely to treat chronically infected total knee arthroplasties with a high success result. However, difficulty in surgical exposure during revision has been encountered. The purpose of this study was to evaluate the clinical results of two-stage reimplantation of an infected total knee arthroplasty using a static antibiotic-impregnated cement spacer.

METHODS: Thirty-one patients (32 knees) with infected total knee arthroplasty had a two-stage reimplantation using a static antibiotic-impregnated cement spacer. Twelve (37.5%) of 32 knees required a V-Y quadricepsplasty and five (15.6%) required a quadriceps snip for surgical exposure at revision. One patient was lost to follow-up and three patients died of unrelated causes. The remaining 27 patients (28 knees) returned at a mean of 68.3 months (8-197 months) for clinical evaluation.

RESULTS: Four knees (14%) had recurrent infection. The mean Knee Society score improved from 40 points preoperatively to 82 points postoperatively. The mean functional score improved from 10 points preoperatively to 60 points postoperatively. The mean range of knee motion improved from 57 degrees preoperatively to 88 degrees at the latest follow-up. Three knees with V-Y quadricepsplasty developed an extension lag from 20 degrees to 45 degrees and three knees had a patella baja postoperatively.

CONCLUSION: Two-stage reimplantation of an infected total knee arthroplasty using a static antibiotic-cement spacer achieved an infection control rate of 86% and improvement in the clinical results. However, weakness of the extensor mechanism of the knee associated with a V-Y quadricepsplasty, which was required in a high percentage of patients during revision surgery in our

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