Two-stage reimplantation for the salvage of infected total knee arthroplasty

Abstract

The results of eleven two-stage reimplantations to salvage eleven infected total knee arthroplasties in ten women (seven with osteoarthritis and three with rheumatoid arthritis) were evaluated after an average follow-up of thirty-four months. The staged procedures included removal of all of the components of the prosthesis and all cement, then six weeks of parenteral antibiotic therapy (monitored by maintaining serum bactericidal levels at a peak dilution of 1:8), and finally reimplantation with a total condylar-type prosthesis. All antibiotics were discontinued after reimplantation. At follow-up, no patient had had a recurrence of the original infection, but one had a hematogenous infection with a different organism secondary to an infected bunion. The results after reimplantation were rated excellent in five knees, good in four, and fair in two. Weakness of the extensor mechanism with an extension lag was the most frequent complication. We do not believe that antibiotic therapy alone is adequate for the management of an infection around a prosthesis. The method described appears to be effective but it is costly and time-consuming. The surgical procedures and medical management are technically difficult, often special equipment and a custom-made prosthesis are required, and there are no shortcuts.