Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty

Abstract

From 1976 to 1992, 24 knees (24 patients) were treated for reinfection after reimplantation of a prosthesis to treat an infected total knee arthroplasty. Including the index total knee arthroplasty, the average number of total procedures for the affected knee was 9.3 procedures (range, 5-23 procedures), and surgical procedures used for the affected knee after reinfection averaged 3.7 procedures (range, 1-12 procedures). The final outcome included 10 knees with a successful knee arthrodeses, 5 patients with infected prostheses who were prescribed suppressive oral antibiotic treatment, 4 above the knee amputations, 3 persistent pseudarthroses of the knee joint, 1 resection arthroplasty, and 1 uninfected total knee prosthesis. A poor prognosis was associated with use of a hinged knee design: 3 of the 4 amputations were done after a hinge knee prosthesis was implanted; 2 patients had a persistent pseudarthrosis after a failed attempt at knee arthrodesis; 1 patient had a resection arthroplasty; and 1 patient had a retained infected prosthesis. A successful arthrodesis in which the initial attempt included use of an external fixation devices was more likely for prostheses without stems (75%) when compared with cemented stemmed prostheses (40%). Long intramedullary arthrodesis was successful in all 3 attempts. Aspiration for diagnosis followed by oral antibiotic suppression was universally unsuccessful in 4 patients, whereas early aggressive open debridement facilitated retention of the prosthesis in 4 of 6 patients. The increased difficulty in achieving a healed wound, a successful knee arthrodesis, and eradication of infection with subsequent nonprosthetic salvage procedures as well as the attendant morbidity associated with reinfection must be considered carefully and discussed with the patient before the reimplantation prosthesis is inserted to treat the infected total knee arthroplasty.