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2-stage reimplantation for infected total knee replacement
R T Goldman1, G R Scuderi, J N Insall
1Morristown Memorial Hospital, NJ, USA.
Clinical Orthopaedics and Related Research
|October 1, 1996
Summary
This study shows that a 2-stage reimplantation protocol effectively treats infected total knee replacements, achieving good long-term function and survivorship. The treatment eradicates deep infection, offering patients a successful outcome comparable to revision surgery.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
Background:
- Deep infection following total knee replacement (TKR) presents a significant challenge.
- Effective treatment strategies are crucial for limb salvage and functional recovery.
Purpose of the Study:
- To evaluate the clinical outcomes and survivorship of a 2-stage reimplantation protocol for infected TKRs.
- To assess the efficacy of a 6-week parenteral antibiotic course in eradicating infection.
Main Methods:
- A cohort of 60 patients with 64 infected TKRs underwent a 2-stage reimplantation.
- Protocol involved prosthesis removal, debridement, 6 weeks of parenteral antibiotics, and new prosthesis implantation.
- Clinical results and survivorship were assessed at an average follow-up of 7.5 years.
Main Results:
- 9% reinfection rate, with only 2 cases caused by the same organism.
- Functional outcomes included 18 excellent, 28 good, 13 fair, and 5 poor results based on the Hospital for Special Surgery knee score.
- 10-year predicted survivorship for 2-stage reimplantation was 77.4%.
Conclusions:
- Two-stage reimplantation with a prolonged parenteral antibiotic course is an effective method for eradicating deep knee joint infections.
- This protocol yields functional results and long-term survivorship comparable to aseptic TKR revisions.