Two-Stage Reimplantation for the Salvage of Infected Total Knee Arthroplasty

Background Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate. Questions/purposes We compared The Knee Society Score Ó (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation. Methods We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8-15 years). Results Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113°v ersus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups. Conclusions We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections.

Section: Methodsmentioning

confidence: 99%

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Bruni

Iacono

Sharma

et al. 2013

“…The success of two-stage reimplantation for infection has ranged from 80% to 100% [5,19,30,37,39,40]. The routine use of stems in revision TKA improves survival rates by enhancing the stability of the prosthesis [7,8,20,29].…”

Section: Introductionmentioning

confidence: 99%

Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties?

Edwards

Fehring

Hamilton

et al. 2014

Background The routine use of stems in revision TKA improves survival rates by enhancing the stability of the prosthesis. The ideal method of stem fixation (cemented or uncemented) in two-stage reimplantation remains controversial. Questions/purposes The purpose of this study was to answer the following questions: (1) Are rerevision rates for aseptic loosening comparable between cemented stems and uncemented stems in two-stage reimplantation? (2) Is the reinfection rate comparable between antibiotic-impregnated cemented stems and uncemented stems for two-stage reimplantation? (3) Are there any differences in Knee Society radiographic scores between stem techniques? Methods A retrospective analysis was performed in all patients who underwent two-stage reimplantation between 1990 and 2010 at Anderson Orthopaedic Research Institute (AORI) and OrthoCarolina (OC). One hundred fourteen patients with 228 stems met the inclusion criteria. Of these 228 stems, 102 stems were cemented and 126 stems were uncemented. The indication for stem fixation was largely institution specific; AORI used cementless stems 92% (118) of the time, whereas OC used a cemented stem 92% (92) of the time. A 2-year minimum radiographic and clinical followup was required for inclusion into the study. Radiographic evaluations were performed using a modification of the Knee Society radiographic score. Results Rerevision rates for aseptic loosening were comparable with three cemented and three cementless stem constructs. The reinfection rate was also comparable between cemented and cementless stems (p = 0.86). Using post hoc analysis, 32% of cemented stems were radiographically classified as loose or closely observe (33 of 102) compared with 17% of the cementless stem group (21 of 126; p = 0.006). Patients with good bone quality had a

“…Insall et al [29] originally proposed the two-stage revision protocol for infected TKA, which many have considered the gold standard for control of deep periprosthetic infection [3,49,51]. This protocol involved the use of antibiotic loaded cement spacers for an interval period, with intravenous antibiotics and the use of antibiotic loaded cement for prosthesis fixation at the time of reimplantation.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Gold Standard: A Review of 253 Two-Stage Revisions for Infected TKA

Mahmud

Lyons

Naudie

et al. 2012

124

Background Periprosthetic joint infection has been the leading cause of failure following TKA surgery. The gold standard for infection control has been a two-staged revision TKA. There have been few reports on mid-to longterm survivorship, functional outcomes, and fate of patients with a failed two-stage revision TKA. Questions/purposes Therefore, we determined (1) the mid-term survivorship of two-stage revision TKA, (2) the function of patients in whom infection was controlled, and (3) the outcome of patients with a failed two-stage revision due to recurrent infection. Methods We retrospectively reviewed 239 patients who underwent 253 two-stage revision TKAs for periprosthetic infection. There were 239 patients (253 knees), 104 men and 135 women, with a mean age of 70 ± 10 years at the time of two-stage revision and a mean BMI of 31.53 ± 6.74 kg/m 2 . During followup, we obtained WOMAC and The Knee Society Clinical Rating Scores and radiographs.