J Korean Orthop Assoc.  2009 Oct;44(5):533-541. 10.4055/jkoa.2009.44.5.533.

Two-Stage Reimplantation of Infected Total Knee Arthroplasty with Antibiotic-Loaded Bone Cement Spacer: Comparison of the Types of Antibiotic-Loaded Cement Spacer

Affiliations
  • 1Department of Orthopaedic Surgery, Pusan National University School of Medicine, Busan, Korea. jtsuh@pusan.ac.kr

Abstract

PURPOSE
The treatment results of a two-stage reimplantation of infected total knee arthroplasty with either the articulating or non-articulating types of antibiotic-loaded bone cement spacers were compared and analyzed. MATERIALS AND METHODS: Between July 1995 and October 2005, this study reviewed 29 patients who underwent two-stage reimplantation of infected total knee arthroplasty and were followed up for at least 2 years. Of the 29 cases, 12 used articulating and 17 used the non-articulating type. RESULTS: Fifteen cases (52%) showed bacterial growth in the preoperative and intraoperative bacterial culture, and 14 cases (48%) had no growth. 27 cases showed no evidence of reinfection until the last follow up after two-stage reimplantation. One out of the 12 cases in the articulating group and 1 out of the 17 cases in the non-articulating group had a reinfection. The range of motion (ROM) of the knee joint and HSS knee rating scale increased more significantly in the articulating group than in the non-articulating group, and the degree of increase in the ROM of the knee joint and HSS knee rating scale was significantly larger in the articulating group. CONCLUSION: The two-stage reimplantation with an antibiotic-loaded bone cement spacer showed a 93.1% of success rate. The articulating group showed better results in the knee ROM and HSS knee rating scale than the non-articulating group

Keyword

Infected total knee arthroplasty; Two stage reimplantation; Antibiotic-loaded bone cement spacer; Articulating; Non-articulating

MeSH Terms

Arthroplasty
Follow-Up Studies
Humans
Knee
Knee Joint
Range of Motion, Articular
Replantation

Figure

  • Fig. 1 This 65 year-old woman visited our clinic with infection of left total knee arthroplasty that was done in other hospital 39 months ago (A). We performed the first stage reimplantation with non-articulating cement spacer and beads (B). Infection was controlled 8 weeks after the first stage reimplantation, then we performed the second stage reimplantation (C). At last follow up (52 months after reimplantation), ROM of left knee joint was 110° and HSS rating scale was 75 points, which were 78° and 47 points preoperatively.

  • Fig. 2 This 68 year-old woman visited our clinic with infection of left total knee arthroplasty that was done in other hospital 4 months ago (A). We performed the first stage reimplantation with articulating cement spacer (B). Infection was controlled 6 weeks after the first stage reimplantation, then we performed the second stage reimplantation (C). At last follow up (38 months after reimplantation), ROM of left knee joint was 103° and HSS rating scale was 89 points, which were 60° and 44 points preoperatively.

  • Fig. 3 In articulating group, non-antibiotics loaded cement was applied on the surface of femoral component of implant or trial and separated after it has gone hard, hence a mold was made. Antibiotic oint was applied on the inner surface of the mold to avoid the antibiotic loaded cement sticking to the mold. Antibiotic loaded cement was applied to the exposed femur in dough phase and the mold was attached to it. Then, the attachment of the two parts was pressed until the cement fuse on each parts. After the fusion of cement, the mold was removed using osteotome.


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