Two-Stage Revision for Infected Knee Endoprosthesis

Abstract

Abstract Introduction. Two-stage revision surgery for infected knee endoprosthesis using antibiotic articulating spacer is the best possible standard in most of the orthopedic centers worldwide. Methods. In the period from 2008 to 2012 we treated 21 patients with infected knee endoprosthesis. We used a single protocol for diagnosis and treatment of infection which included x-ray examination, serological examination (sedimentation and CRP), fine needle aspiration of the joint with further microbiological and biochemical examination of the smear. The surgical treatment was consisted of taking samples for microbiological and histological examination, removing the implanted endoprosthesis and excision of the avascular and necrotic tissue, implantation of articular antibiotic spacer. The postoperative steps included administration of parenteral antibiotics according to the previously made antibiogram in a two-week period followed by two oral antibiotics (ciprofloxacin and rifampicin) in the next four to six weeks. The second-stage procedure was performed when there were no clinical and serological signs of infection. Removing of the antibiotic spacer and implanatation of primary or revision prosthesis according to bone deficit was performed. Results. In one patient the procedure was carried out three times, arthrodesis of the knee joint was made in one patient and in nineteen patients reimplantation was performed. One patient after reimplanation had reinfection after 6 months. The follow-up period of the patients was 36 months. The functional results according to the Knee society score: preoperative 36, postoperative 74. Conclusion. Two-phase treatment is satisfactory in treatment of periprosthetic joint infection. Articulated antibiotic loaded bone cement spacer is superior in eradication of local infection. It allows partial function of the joint and makes easier the second surgical intervention. Infection with Staphylococcus aureus is difficult to be treated with a higher percent of recidives.