Single-stage revision for treatment of infected total knee arthroplasty

Abstract

Objective To evaluate the short term clinical results of single-stage revision for infected total knee arthroplasty （TKA）. Methods Twenty-two unilateral infected TKA were revised through onestage implant exchange using antibiotics loaded cement from April 2005 to December 2009. Sixteen patients who were followed up at least 6 months were included in this study. There were 5 male and 11 female with the mean age of 65 years old （range 49 to 75） in this group. Fourteen patients were diagnosed as late chronic infection （〉 4 weeks） and 2 cases as hematogenous spread delayed infection. The average Knee Society Score （KSS） functional score was 37.25±16.23. The average time from primary arthroplasty to revision was 23.9 months （range 2 to 73）. During the operation, the inflammatory, necrotic and scar tissue must be removed radically. Constrained condyle knee （CCK） prosthesis with stem were used in 14 cases with severe bone loss and primary prosthesis were used in 2 cases. All cases were fixed with antibiotics-loaded cement. Results All cases were followed up for the average 25 months （range 6 to 59 months）. Infection recurred in one case who had to undergo another two-stage revision, One case who complained of local knee pain with elevated ESR and CRP 9 months postoperatively responded to appropriate one-month course of antibiotic therapy. The average KSS functional score was 85.88±12.85 and the satisfactory rate was 87.5% at last follow-up. Conclusion Good outcomes can be reached by radical debridement, correct choice of implant, careful perioperative management, and effective antibiotics in single-stage revision for infected TKA. Key words: Arthroplasty, replacement, knee; Infection; Reoperation