Treatment of Infected Total Knee Arthroplasty

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Cementless revision arthroplasty using allograft technique for massive tibial and femoral defects and delayed implantation after debridement was evaluated for the treatment of chronically infected total knee arthroplasties. Thirty-three knees in 33 patients were treated by implant removal and debridement followed by six weeks of antibiotic-impregnated cement beads and intravenous antibiotics. Cultures of synovial tissue taken at surgery grew Staphylococcus epidermidis in 18 knees, Staphylococcus aureus in five knees, Enterococcus in five knees, Pseudomonas in four knees, and mixed gram-negative organisms in one knee. Intravenous antibiotics were given accordingly. A pain-free, nondraining wound was achieved with the first incision and drainage in 28 knees, whereas four knees required one or two subsequent procedures to achieve a dry wound and weight-bearing function. One knee continued to drain after repeated attempts at revision and fusion, and amputation above the knee was done at another institution. Cementless reconstruction using antibioticsoaked bone graft and rigidly fixed femoral and tibial components was successful in 32 of 33 knees, with intermediate term follow-up examinations. Extensive debridement, followed by a six-week waiting period, produced a dry wound and painfree knee in most patients. Those who developed recurrent infection responded well to repeat debridement, and all but one have remained free of clinically apparent infection two to eight years after surgery. Repeat debridement, antibiotic-impregnated cement beads, and bone grafting were uncommonly necessary, but the four patients that required them did not lose bone stock with subsequent revisions. All but one patient achieved stable fixation of the implants and good function of the knee. Two years after surgery, 23 patients complained of no pain in the knee, seven complained of mild pain, two complained of moderate pain, and two complained of severe pain. The mean range of motion was 2° to 100° at the two-year postoperative evaluation. In the intermediate term, this method was successful in restoring function, reconstructing bone stock, and eradicating infection.

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