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The Journal of Bone and Joint Surgery, Vol 65, Issue 8 1087-1098, Copyright © 1983 by Journal of Bone and Joint Surgery, Inc
Two-stage reimplantation for the salvage of infected total knee arthroplasty
JN Insall, FM Thompson and BD Brause
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.
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