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Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer
BACKGROUND: A two-stage revision remains as the "gold standard" treatment for chronically infected total knee arthroplasties. METHODS: Forty-five septic knee prostheses were revised with a minimum follow-up of 5 years. Static antibiotic-impregnated cement spacers were used in all cases. In...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Orthopaedic Association
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758987/ https://www.ncbi.nlm.nih.gov/pubmed/24009903 http://dx.doi.org/10.4055/cios.2013.5.3.180 |
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author | Silvestre, Antonio Almeida, Fernando Renovell, Pablo Morante, Elena López, Raúl |
author_facet | Silvestre, Antonio Almeida, Fernando Renovell, Pablo Morante, Elena López, Raúl |
author_sort | Silvestre, Antonio |
collection | PubMed |
description | BACKGROUND: A two-stage revision remains as the "gold standard" treatment for chronically infected total knee arthroplasties. METHODS: Forty-five septic knee prostheses were revised with a minimum follow-up of 5 years. Static antibiotic-impregnated cement spacers were used in all cases. Intravenous antibiotics according to sensitivity test of the culture were applied during patients' hospital stay. Oral antibiotics were given for another 5 weeks. Second-stage surgery was undertaken after control of infection with normal erythrocyte sedimentation rate and C-reactive protein values. Extensile techniques were used if needed and metallic augments were employed for bone loss in 32 femoral and 29 tibial revisions. RESULTS: The average interval between the first-stage resection and reimplantation was 4.4 months. Significant improvement was obtained with respect to visual analog scale pain and clinical and functional scores, and infection was eradicated in 95.6% of cases following a two-stage revision total knee arthroplasty. Radiographic evaluation showed suitable alignment without signs of mechanical loosening. CONCLUSIONS: This technique is a reasonable procedure to eradicate chronic infection in knee arthroplasty and provides proper functional and clinical results. However, it sometimes requires extensile surgical approaches that could imply arduous surgeries. Metallic augments with cementless stems available in most of the knee revision systems are a suitable alternative to handle bone deficiencies, avoiding the use of bone allografts with its complications. |
format | Online Article Text |
id | pubmed-3758987 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | The Korean Orthopaedic Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-37589872013-09-04 Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer Silvestre, Antonio Almeida, Fernando Renovell, Pablo Morante, Elena López, Raúl Clin Orthop Surg Original Article BACKGROUND: A two-stage revision remains as the "gold standard" treatment for chronically infected total knee arthroplasties. METHODS: Forty-five septic knee prostheses were revised with a minimum follow-up of 5 years. Static antibiotic-impregnated cement spacers were used in all cases. Intravenous antibiotics according to sensitivity test of the culture were applied during patients' hospital stay. Oral antibiotics were given for another 5 weeks. Second-stage surgery was undertaken after control of infection with normal erythrocyte sedimentation rate and C-reactive protein values. Extensile techniques were used if needed and metallic augments were employed for bone loss in 32 femoral and 29 tibial revisions. RESULTS: The average interval between the first-stage resection and reimplantation was 4.4 months. Significant improvement was obtained with respect to visual analog scale pain and clinical and functional scores, and infection was eradicated in 95.6% of cases following a two-stage revision total knee arthroplasty. Radiographic evaluation showed suitable alignment without signs of mechanical loosening. CONCLUSIONS: This technique is a reasonable procedure to eradicate chronic infection in knee arthroplasty and provides proper functional and clinical results. However, it sometimes requires extensile surgical approaches that could imply arduous surgeries. Metallic augments with cementless stems available in most of the knee revision systems are a suitable alternative to handle bone deficiencies, avoiding the use of bone allografts with its complications. The Korean Orthopaedic Association 2013-09 2013-08-20 /pmc/articles/PMC3758987/ /pubmed/24009903 http://dx.doi.org/10.4055/cios.2013.5.3.180 Text en Copyright © 2013 by The Korean Orthopaedic Association http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Silvestre, Antonio Almeida, Fernando Renovell, Pablo Morante, Elena López, Raúl Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer |
title | Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer |
title_full | Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer |
title_fullStr | Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer |
title_full_unstemmed | Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer |
title_short | Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer |
title_sort | revision of infected total knee arthroplasty: two-stage reimplantation using an antibiotic-impregnated static spacer |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3758987/ https://www.ncbi.nlm.nih.gov/pubmed/24009903 http://dx.doi.org/10.4055/cios.2013.5.3.180 |
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