40
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Two-Stage Revision for Infected Total Knee Arthroplasty: Based on Autoclaving the Recycled Femoral Component and Intraoperative Molding Using Antibiotic-Impregnated Cement on the Tibial Side

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          The purpose of this study was to determine the degree of infection control and postoperative function for new articulating metal-on-cement spacer.

          Methods

          A retrospective study of 19 patients (20 cases), who underwent a two-stage revision arthroplasty using mobile cement prosthesis, were followed for a minimum of 2 years. This series consisted of 16 women and 3 men, having an overall mean age of 71 years. During the first stage of revision, the femoral implant and all the adherent cement was removed, after which it was autoclaved before replacement. The tibial component was removed and a doughy state, antibiotic-impregnated cement was inserted on the tibial side. To achieve joint congruency, intraoperative molding was performed by flexing and extending the knee joint. Each patient was evaluated clinically and radiologically. The clinical assessments included range of motion, and the patients were scored as per the Hospital for Special Surgery (HSS) and Knee Society (KS) criteria.

          Results

          The mean range of knee joint motion was 70° prior to the first stage operation and 72° prior to the second stage revision arthroplasty; following revision arthroplasty, it was 113° at the final follow-up. The mean HSS score and KS knee and function scores were 86, 82, and 54, respectively, at the final follow-up. The success rate in terms of infection eradication was 95% (19/20 knees). No patient experienced soft tissue contracture requiring a quadriceps snip.

          Conclusions

          This novel technique provides excellent radiological and clinical outcomes. It offers a high surface area of antibiotic-impregnated cement, a good range of motion between first and second stage revision surgery for the treatment of chronic infection after total knee arthroplasty, and is of a reasonable cost.

          Related collections

          Most cited references30

          • Record: found
          • Abstract: found
          • Article: not found

          Prior use of antimicrobial therapy is a risk factor for culture-negative prosthetic joint infection.

          Clinical characteristics and control of the infection of patients with culture-negative (CN) prosthetic joint infection (PJI) have not been well assessed. Prior use of antimicrobial therapy has been speculated but not proven as a risk factor for CNPJI. We therefore determined whether prior use of antimicrobial therapy, prior PJI, and postoperative wound healing complications were associated with CN PJI. We performed a retrospective case-control study of 135 patients with CN PJI treated between January 1, 1985, and December 31, 2000 matched with 135 patients with culture-positive (CP) PJIs (control patients) during the study period. The time to failure of therapy compared between cases and control patients using a Kaplan-Meier analysis. The use of prior antimicrobial therapy and postoperative wound drainage after index arthroplasty were associated with increased odds of PJI being culture-negative (odds ratio, 4.7; 95% CI, 2.8-8.1 and odds ratio, 3.5; 95% CI, 1.5-8.1, respectively). The percent (+/- SE) cumulative incidence free of treatment failure at 2 years followup was similar for CN and CP PJI: 75% (+/- 4%) and 79% (+/- 4%), respectively. Prior antimicrobial therapy and postoperative wound drainage were associated with an increased risk of negative cultures among patients with PJI. Physicians should critically evaluate the need for antimicrobial therapy before establishing a microbiologic diagnosis of PJI in patients with suspected PJI. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Comparison of a static with a mobile spacer in total knee infection.

              Patients with infections of a total knee arthroplasty were stratified by medical status. Twenty-six knees in 26 patients treated with a static antibiotic-impregnated polymethylmethacrylate block spacer before 1995 were compared with 22 knees in 22 patients treated after 1995 with a mobile articulating spacer. Both groups were treated with 6 weeks of parenteral antibiotics and had reimplantation within 6 to 12 weeks after placement of the spacer. Followup for the patients who had block spacers was an average 7.5 years (range, 2.8-12.7 years), and followup for the patients with a mobile spacer was an average of 3.8 years (range, 2.6-6.4 years). Results showed that the patients with the mobile spacers had significantly better average range of motion at followup compared with patients who had block spacers (107.8 degrees compared with 93.7 degrees ). The reinfection rate was the same between the two groups at 36 months, 7.6% (two of 26) for the patients with block spacers and 9% (two of 22) for the patients with mobile spacers. Extended followup available for the patients who had block spacers revealed a late reinfection rate of 23% (six of 26) with a new organism. There was no difference in the reinfection rate, with new or old organisms, in healthy hosts compared with patients with as many as two medical problems.
                Bookmark

                Author and article information

                Journal
                Clin Orthop Surg
                Clin Orthop Surg
                CIOS
                Clinics in Orthopedic Surgery
                The Korean Orthopaedic Association
                2005-291X
                2005-4408
                September 2015
                13 August 2015
                : 7
                : 3
                : 310-317
                Affiliations
                Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
                Author notes
                Correspondence to: Hee-Soo Kyung, MD. Department of Orthopaedic Surgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu 700-721, Korea. Tel: +82-53-420-5636, Fax: +82-53-422-6605, hskyung@ 123456knu.ac.kr
                Article
                10.4055/cios.2015.7.3.310
                4553278
                26330952
                9aa6aca2-b810-44de-8f7b-caf410256036
                Copyright © 2015 by The Korean Orthopaedic Association

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 September 2014
                : 27 May 2015
                Categories
                Original Article

                Surgery
                articulating spacer,metal-on-cement,infection,total knee arthroplasty,two-stage revision
                Surgery
                articulating spacer, metal-on-cement, infection, total knee arthroplasty, two-stage revision

                Comments

                Comment on this article