Authors: Gerhard Maale MD, and Brian Vickaryous MD
Title: The Infected Total Knee Arthroplasty - A Retrospective Study Of The Treatment Of 59 Infections
Addresses: Dallas-Ft. Worth Sarcoma Group, Presbyterian Hospital Dallas, and William Beaumont Army MC/Texas Tech UHSC E1 Paso, TX
Purpose: To assess outcomes and survivorship after treatment of knee sepsis by a protocol of early exchange arthroplasty with antibiotic impregnated cement.
Methods: We retrospectively evaluated the results of treatment of fifty-nine infected total knee arthroplasties in fifty-eight consecutive referred patients from September 1988 to November 1999. Forty-seven patients were managed with two stage exchange arthroplasty and antibiotic impregnated cement spacer. Six patients underwent three stage exchange, and six were treated with one-stage exchange staged exchange arthroplasty.
Results: The mean duration of follow-up was 4.55 years (range, 0.5 months to 10.8 years). 8 patients did not have minimum two year follow up. One was lost to follow-up secondary to adjudication (auto inoculating self to defer sentencing). Two patients failed treatment, defined as return of the original organism at less than 2 years. Five patients, including the failures, required additional treatment for infection: above knee amputation - 3 patients (2 secondarily infected with Candida albicans at 1.58 and 0.58 years, and one with MRSA at 5 years), suppressive antibiotics (1 patient deferred AKA), one new organism 2.19 years later precipitated exchange arthroplasty. Four flaps of 29 primary soft tissue procedures failed. Three additional flaps were performed in the exchange period that allowed retention of prosthesis to follow-up. There were 21 perioperative complications, 34 late complications, 9 dislocations, and 18 antibiotic related events.
Conclusion And Discussion: Our protocol of exchange arthroplasty is an acceptable treatment for control in the setting of infected joint arthroplasty. Avoiding and treating complications necessitates a team approach.