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J Knee Surg 2017; 30(03): 231-237
DOI: 10.1055/s-0036-1584190
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antibiotic-Loaded Spacer for Two-Stage Revision of Infected Total Knee Arthroplasty

Eugenio Vecchini
1   Orthopedic Division, Department of Surgery, University of Verona, Verona, Italy
,
Gian Mario Micheloni
1   Orthopedic Division, Department of Surgery, University of Verona, Verona, Italy
,
Francesco Perusi
1   Orthopedic Division, Department of Surgery, University of Verona, Verona, Italy
,
Marco Scaglia
2   Orthopedic Division, Presidio Ospedaliero di Conegliano, Treviso, Italy
,
Tommaso Maluta
1   Orthopedic Division, Department of Surgery, University of Verona, Verona, Italy
,
Franco Lavini
1   Orthopedic Division, Department of Surgery, University of Verona, Verona, Italy
,
Manuel Bondi
3   Orthopedic Division, Ospedale Carlo Poma, Mantova, Italy
,
Carlo Dall'Oca
1   Orthopedic Division, Department of Surgery, University of Verona, Verona, Italy
,
Bruno Magnan
1   Orthopedic Division, Department of Surgery, University of Verona, Verona, Italy
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Publikationsverlauf

08. August 2015

10. April 2016

Publikationsdatum:
20. Mai 2016 (online)

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Abstract

Infection of total knee arthroplasty (TKA) is a challenge in orthopedic surgery. In literature TKA infection is classified according to the time after surgery: acute postoperative; late chronic; acute hematogenous; positive intraoperative microbiological growth. The purpose of this study is to present the results of the use of a preformed antibiotic-loaded spacer in TKA infections, treated by a two-stage revision procedure. A series of 19 consecutive patients (20 knees) with a diagnosis of infected TKA were treated from January 2003 to February 2012. Two-stage reimplantation protocols were completed only in 16 patients and these data were included in the study. We lost three patients at follow-up. An antibiotic-loaded preformed articulating polymethylmethacrylate spacer was applied. Patients were observed 1, 3, and 6 months postoperatively and then yearly for clinical and radiographic examination. The mean American Knee Society Score improved from 68.4 preoperatively (range, from 34 to 108) to 112.7 at final follow-up (range, from 49 to 180). The pain was evaluated as part of clinical score. It improved from an average of 19.3 preoperatively (range, from 10 to 30) to 34.3 at final follow-up (range, from 10 to 50). The average range of motion improved from 40.1 degrees (range, from 6 to 90 degrees) to 79.3 degrees (range, from 45 to 125 degrees). The use of the spacer allows obtaining a reduction of pain, an improvement of quality of life in the period of time between the two surgical stages and an easier reimplantation of TKA.

Keywords

antibiotic spacer - TKA infections - revision surgery