Two-stage reimplantation without cement spacer for septic total knee replacement

The management of an infected total knee implant is a major challenge to the orthopedic surgeon. We report the outcome using two-stage reimplantation without cement spacers between stages.

Seven infected total knee replacements (TKR) were treated with the two-stage reimplantation technique from September 1994 through January 2001. Treatment of these patients consisted of thorough debridement and removal of the implants. No antibiotic-impregnated cement blocks or beads were inserted and only a long leg cylinder cast was applied for immobilization between stages. Intravenous antibiotics were used and C-reactive protein (CRP) values were monitored. All of the patients were free of infection and revision TKR was performed without using antibiotic-impregnated cement for fixation at an average interval of 6.3 weeks (range 6-10 weeks).

The average length of follow-up was 3.5 years (range 1-7 years) and the average HSS (Hospital for Special Surgery) knee score was 86 points (range 78-94). A good result was obtained in one patient and excellent results in six patients. Average range of motion was 91 degrees (range 80 degrees -100 degrees ). No recurrence of infection was noted.

Two-stage reimplantation without using a cement spacer between stages for septic total knee replacement is tolerable for patients, simpler for surgeons and can achieve good results without recurrence of infection.