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How I do it - Second stage revision total knee arthroplasty
1Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK.
Background:
Infection is a potentially devastating complication following primary total knee arthroplasty, and the traditional gold-standard treatment for chronic prosthetic joint infection has been in the form of a two-stage revision total knee arthroplasty. This involves a first stage - removal of all implants and infected material, with implantation of a temporary spacer - followed by a second stage which includes reimplantation with a definitive prosthesis.
Indications:
Although the outcomes of single-stage and two-stage revision arthroplasty surgeries are similar, there are certain indications such as atypical or more virulent organisms, patient factors and soft tissue factors that would favour a two-stage approach.
Surgical Technique:
The second stage revision procedure consists of explantation of the spacer with a debridement and synovectomy. Further samples are sent for microbiological analysis. Once the surgical field is clean and lavaged, the definitive prosthesis is implanted.
Conclusions:
A second stage revision total knee arthroplasty is a reliable procedure for the treatment of chronic prosthetic joint infection. There is a significant re-revision rate, predominantly due to recurrent deep infection.
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