Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan 3;2(1):e077.
doi: 10.5435/JAAOSGlobal-D-17-00077. eCollection 2018 Jan.

Knee Arthrodesis Outcomes After Infected Total Knee Arthroplasty and Failure of Two-stage Revision With an Antibiotic Cement Spacer

Matthew Robinson  1 , Hristo I Piponov  1 , Andrew Ormseth  1 , Cory W Helder  1 , Brian Schwartz  1 , Mark H Gonzalez  1
Affiliations

Knee Arthrodesis Outcomes After Infected Total Knee Arthroplasty and Failure of Two-stage Revision With an Antibiotic Cement Spacer

Matthew Robinson et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Background: Reinfected total knee arthroplasty can be managed with a second two-stage exchange or a knee arthrodesis procedure.

Methods: Twenty-three patients with knee arthrodesis after failed exchange arthroplasty for infection were reviewed. Patients were managed with a staged protocol of implant extraction, débridement, and implantation of an antibiotic spacer, with subsequent arthrodesis. Follow-up averaged 40.4 months, with a minimum of 1 year.

Results: Bony union with eradication of infection was achieved in 20/23 knees. Sixteen of the 20 patients were able to ambulate with minimal pain. The average time to union was 11.3 months, and the average leg length discrepancy was 4.85 cm. The average Knee Society Score after arthrodesis was 44, and the average visual analog scale pain score was 1.73. Three patients underwent above-knee amputation.

Discussion: Knee arthrodesis performed for persistent periprosthetic infection allowed for eradication of infection and union in 87% of the patients, creating a stable knee fusion.

PubMed Disclaimer

Conflict of interest statement

Dr. Schwartz or an immediate family member is an employee of Abbott and has stock or stock options held in Conformiz. Dr. Gonzalez or an immediate family member serves as a board member, owner, officer, or committee member of the American Society for Surgery of the Hand; has received royalties from Biomet, Johnson & Johnson, and Zimmer; has stock or stock options held in Ortho Sensing Technology; and serves as a paid consultant to Smith & Nephew. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Robinson, Dr. Piponov, and Mr. Helder.

Figures

Figure 1
Figure 1
A, AP radiograph of fusion with intramedullary nail arthrodesis. B, AP radiograph of arthrodesis with an external fixation device.
Figure 2
Figure 2
Overview of the treatments used in the 23 patients. AKA = above-knee amputation, IM nail = intramedullary nail, THA = total hip arthroplasty.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Watanabe K, Minowa T, Takeda S, et al. : Outcomes of knee arthrodesis following infected total knee arthroplasty: A retrospective analysis of 8 cases. Mod Rheumatol 2014;24:243-249. - PubMed
    1. Gooding CR, Masri BA, Duncan CP, Greidanus NV, Garbuz DS: Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res 2011;469:985. - PMC - PubMed
    1. Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ: Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 2007;89:871. - PubMed
    1. Emerson RH, Jr, Muncie M, Tarbox TR, Higgins LL: Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res 2002;404:132-138. - PubMed
    1. Haddad FS, Masri BA, Campbell D, McGraw RW, Beauchamp CP, Duncan CP: The PROSTALAC functional spacer in two-stage revision for infected knee replacements: Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br 2000;82:807. - PubMed