Abstract
We performed a prospective study to assess safety and effectiveness of a pre-formed articulating spacer made of gentamicin-impregnated acrylic cement in the management of infected total knee arthroplasty. Twenty-one consecutive patients with unilateral deep infection were treated by two-stage revision in two centres. Two patients were excluded, and 19 patients remained available for assessment. The mean implantation time of the spacer was 12 weeks. The rehabilitation programme between stages consisted in early range of motion exercises and partial weight bearing. Mean follow-up after removal of the spacer and insertion of the final prosthesis was 24 (range, 12–43) months. No patient had recurrence of infection at the latest follow-up. The mean Knee Society functional score during spacer management was rated 75 points and was rated 84 points at the latest follow-up. No device-related complication was observed.
Résumé
Nous avons étudié prospectivement la sécurité et l’efficacité d’un espaceur articulé pré-formé fait en ciment acrylique imprégné de gentamicine dans la gestion de l’arthroplastie totale infectée du genou. Vingt et un malades consécutifs avec une infection profonde monolatérale ont été traités dans deux centres, avec une révision en deux temps. Deux malades ont été exclus, et 19 malades sont restés disponibles pour l’estimation. Le temps d’implantation moyen de l’espaceur était de 12 semaines. La rééducation entre les deux étapes a consisté en un travail précoce de la mobilité et un appui partiel. Le suivi moyen après réimplantation prothétique était de 24 mois (12 à 43 mois). Aucun malade n’avait de récidive de l’infection au dernier recul. Le score fonctionnel moyen (Knee Society) pendant le port de l’espaceur a été estimé à 75 points et à 84 points au dernier recul. Aucune complication liée à l’espaceur n’a été observée.
Full Text
The Full Text of this article is available as a PDF (111.2 KB).
References
- 1.Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D. Total knee replacement in young, active patients. Long term of follow-up and functional outcome. J Bone Joint Surg Am. 1997;79:575–582. doi: 10.2106/00004623-199704000-00015. [DOI] [PubMed] [Google Scholar]
- 2.Duncan CP, Beauchamp C. A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip. Orthop Clin North Am. 1993;24:751–759. [PubMed] [Google Scholar]
- 3.Engh GA. Bone defect classification. In: Engh GA, Rorabeck CH, editors. Revision total knee arthroplasty. Baltimore: William & Wilkins; 1997. p. 63. [Google Scholar]
- 4.Goksan SB, Freeman MA. One stage reimplantation for infected total knee arthroplasty. J Bone Joint Surg Br. 1992;74:78–82. doi: 10.1302/0301-620X.74B1.1732271. [DOI] [PubMed] [Google Scholar]
- 5.Haddad FS, Masri BA, Campbell D, McGraw RW, Beauchamp CP, Duncan CP. The Prostalac functional spacer in two-stage revision for infected knee replacement. J Bone Joint Surg Br. 2000;82:807–812. doi: 10.1302/0301-620X.82B6.10486. [DOI] [PubMed] [Google Scholar]
- 6.Hanssen AD, Rand JA, Osmon DR. Treatment of the infected total knee arthroplasty with insertion of another prosthesis. The effect of antibiotic-impregnated bone cement. Clin Orthop. 1994;309:44–55. [PubMed] [Google Scholar]
- 7.Hofmann AA, Kane KR, Tkach TK, Plaster RL, Camargo MR. Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop. 1995;321:45–54. [PubMed] [Google Scholar]
- 8.Insall JN. Infection of total knee arthroplasty. AAOS Instr Course Lect. St. Louis: CV Mosby; 1986. p. 319. [PubMed] [Google Scholar]
- 9.McPherson EJ, Lewonoswski K, Dorr LD. Techniques in arthroplasty. Use of an articulated PMMA spacer in the infected total knee arthroplasty. J Arthroplast. 1995;10:87–89. doi: 10.1016/S0883-5403(05)80105-6. [DOI] [PubMed] [Google Scholar]
- 10.Meek RM, Masri BA, Dunlop D, Garbuz DS, Greidanus NV, McGraw R, Duncan CP. Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer. J Bone Joint Surg Am. 2003;85:1888–1892. doi: 10.1302/0301-620X.85B8.14214. [DOI] [PubMed] [Google Scholar]
- 11.Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop. 2001;392:15–23. [PubMed] [Google Scholar]
- 12.Pitto RP, Spika IA. Antibiotic-loaded bone cement spacers for the two-stage management of the infected total knee arthroplasty. Int Orthop. 2004;28:129–133. doi: 10.1007/s00264-004-0545-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Ranawat CS, Flynn WF, Jr, Saddler S, Hansraj KK, Maynard MJ. Long-term results of the total condylar knee arthroplasty. Clin Orthop. 1993;286:94–102. [PubMed] [Google Scholar]
- 14.Robertsson O, Knutson K, Lewold S, Goodman S, Lidgren L. Knee arthroplasty in rheumatoid arthritis. A report from the Swedish Knee Arthroplasty Register on 4381 primary operations 1985–1995. Acta Orthop Scand. 1997;68:545–553. doi: 10.3109/17453679708999024. [DOI] [PubMed] [Google Scholar]
- 15.Salvati EA, Robinson RP, Zeno SM, Koslin BL, Brause BD, Wilson PD., Jr Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am. 1982;64:525–535. [PubMed] [Google Scholar]
- 16.Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am. 1999;81:1434–1445. doi: 10.2106/00004623-199910000-00008. [DOI] [PubMed] [Google Scholar]
- 17.Scott IR, Stockley I, Getty CJM. Exchange arthroplasty for infected knee replacements. A new two-stage method. J Bone Joint Surg Br. 1993;75:28–31. doi: 10.1302/0301-620X.75B1.8421028. [DOI] [PubMed] [Google Scholar]
- 18.Walker RH, Schurman DJ. Management of infected total knee arthroplasties. Clin Orthop. 1984;186:81–89. [PubMed] [Google Scholar]
- 19.Whiteside LA. Treatment of infected total knee arthroplasty. Clin Orthop. 1994;321:169–172. [PubMed] [Google Scholar]
- 20.Wilde AH, Ruth JT. Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop. 1988;236:23–35. [PubMed] [Google Scholar]
- 21.Windsor RE, Bono JV. Infected total knee replacements. J Am Acad Orthop Surg. 1994;2:44–53. doi: 10.5435/00124635-199401000-00006. [DOI] [PubMed] [Google Scholar]