Two-stage total infected knee arthroplasty treatment with articulating cement spacer. 2010

Ali Ocguder, and Ahmet Firat, and Osman Tecimel, and Sukru Solak, and Murat Bozkurt
3rd Orthopaedics and Traumatology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.

BACKGROUND The treatment of infected total knee arthroplasty (TKA) is controversial and various. Two-stage prolonged reimplantation and 6-week systemic antibiotics use have been a gold standard of treatment in recent years. METHODS Seventeen knees of 17 patients, who underwent primary TKA and subsequently developed infections, were implanted articulating antibiotic-loaded cement spacer through two-stage reimplantation. In the postoperative period, parenteral antibiotic treatment targeting the specific microorganism detected in each patient was started and continued with oral administration. The mean total (parenteral and oral) antibiotic treatment time was 6.8 weeks (6-10). The spacer remained in its location until complete soft tissue recovery and normal values for laboratory parameters were achieved. The mean time interval between spacer implantation and reimplantation was 4.2 months (3-6). RESULTS In the last follow-up examinations of the patients, conditions requiring reoperation were detected in 3 patients (17.6%). In 2 of these patients (11.7%), infection developed after a mean 1-year interval. The joint motion ranges of the patients were measured in the preoperative period, during spacer use, and following reimplantation. The mean joint motion range of the patients was 58 degrees (12-90) in the preoperative period; in the presence of spacer between the two stages, 69 degrees (15-100); and in the last follow-up examination after reimplantation, 95 degrees (10-120). CONCLUSIONS Use of articulating cement spacer in the treatment of infected TKA is efficient and reliable.

UI MeSH Term Description Entries
D007720 Knee Prosthesis Replacement for a knee joint. Knee Prostheses,Prostheses, Knee,Prosthesis, Knee
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D012086 Reoperation A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery. Revision, Joint,Revision, Surgical,Surgery, Repeat,Surgical Revision,Repeat Surgery,Revision Surgery,Joint Revision,Revision Surgeries,Surgery, Revision
D001843 Bone Cements Adhesives used to fix prosthetic devices to bones and to cement bone to bone in difficult fractures. Synthetic resins are commonly used as cements. A mixture of monocalcium phosphate, monohydrate, alpha-tricalcium phosphate, and calcium carbonate with a sodium phosphate solution is also a useful bone paste. Bone Cement,Bone Glues,Bone Pastes,Bone Glue,Bone Paste,Cement, Bone,Cements, Bone,Glue, Bone,Glues, Bone,Paste, Bone,Pastes, Bone
D003646 Debridement The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. (Dorland, 27th ed) Debridements
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000900 Anti-Bacterial Agents Substances that inhibit the growth or reproduction of BACTERIA. Anti-Bacterial Agent,Anti-Bacterial Compound,Anti-Mycobacterial Agent,Antibacterial Agent,Antibiotics,Antimycobacterial Agent,Bacteriocidal Agent,Bacteriocide,Anti-Bacterial Compounds,Anti-Mycobacterial Agents,Antibacterial Agents,Antibiotic,Antimycobacterial Agents,Bacteriocidal Agents,Bacteriocides,Agent, Anti-Bacterial,Agent, Anti-Mycobacterial,Agent, Antibacterial,Agent, Antimycobacterial,Agent, Bacteriocidal,Agents, Anti-Bacterial,Agents, Anti-Mycobacterial,Agents, Antibacterial,Agents, Antimycobacterial,Agents, Bacteriocidal,Anti Bacterial Agent,Anti Bacterial Agents,Anti Bacterial Compound,Anti Bacterial Compounds,Anti Mycobacterial Agent,Anti Mycobacterial Agents,Compound, Anti-Bacterial,Compounds, Anti-Bacterial

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