TWO-STAGE REVISION OF INFECTED TOTAL KNEE ARTHROPLASTY USING ANTIBIOTIC-IMPREGNATED ARTICULATING CEMENT SPACER_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Pengde , HU Yihe , XIE Jie , WANG Long.

Department of Orthopedics, Xiangya Hospital of Central South University, Changsha Hunan, 410008, P.R.China. Corresponding author: HU Yihe, E-mail: doctorhuyihe19641022@yahoo.com.cn;

Corresponding author：

Keywords：

Total knee arthroplasty; Late infection; Two-stage revision; Antibiotic-impregnated articulating cement spacer

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Objective To investigate the effectiveness of two-stage revision of infected total knee arthroplasty (TKA) using an antibiotic-impregnated articulating cement spacer. Methods The clinical data were analyzed from 23 patients (23 knees) undergoing two-stage revision for late infection after primary TKA between January 2007 and December 2009. There were 15 males and 8 females, aged from 43 to 75 years (mean, 65.2 years). Infection occurred at 13-52 months (mean, 17.3 months) after TKA. The time interval between infection and admission ranged from 15 days to 7 months (mean, 2.1 months). One-stage operation included surgical debridement and removal of all knee prosthesis and cement, then an antibiotic-impregnated articulating cement spacer was implanted. The re-implantation of prosthesis was performed after 8-10 weeks when infections were controlled. The American Hospital for Special Surgery (HSS) score and Knee Society Score (KSS) were used to compare the function of the knee between pre- and post-revision. The rate of infection control and complication were analyzed. Results All incisions healed primarily. Re-infection occurred in 2 cases after two-stage revision, and infection was controlled in the other 21 cases, with an infection control rate of 91.3%. The patients were followed up 2-5 years (mean, 3.6 years). The HSS score was increased from 60.6 ± 9.8 at pre-revision to 82.3 ± 7.4 at last follow-up, the KSS score was increased from 110.7 ± 9.6 at pre-revision to 134.0 ± 10.5 at last follow-up, all showing significant differences (P lt; 0.01). Radiographs showed that prosthesis had good position with no loosening, fracture, or periprosthetic radiolucent. Conclusion Two-stage revision using an antibiotic-impregnated articulating cement spacer is an effective method to control infected TKA and to restore the function of affected knee.

Citation： CAI Pengde,HU Yihe,XIE Jie,WANG Long.. TWO-STAGE REVISION OF INFECTED TOTAL KNEE ARTHROPLASTY USING ANTIBIOTIC-IMPREGNATED ARTICULATING CEMENT SPACER. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(10): 1169-1173. doi: Copy

1.	Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis, 2006, 42(4): 471-478.
2.	Salgado CD, Dash S, Cantey JR, et al. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res, 2007, 461: 48-53.
3.	Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res, 2008, 466(7): 1710-1715.
4.	Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
5.	Ong KL, Mowat FS, Chan N, et al. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res, 2006, (446): 22-28.
6.	Oduwole KO, Molony DC, Walls RJ, et al. Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 945-948.
7.	Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg (Am), 2008, 90(8): 1637-1643.
8.	Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
9.	Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
10.	史占军, 肖军, 李朋. 人工关节置换术后假体周围感染的诊断. 中华骨科杂志, 2010, 30(6): 626-629.
11.	Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
12.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
13.	曹力, 阿斯哈尔江, 张晓岗, 等. 一期翻修术治疗全膝关节置换术后感染. 中华骨科杂志, 2011, 31(2): 131-136.
14.	Cordero-Ampuero J, Esteban J, García-Cimbrelo E, et al. Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2-9 years. Acta Orthop, 2007, 78(4): 511-519.
15.	Hsu CS, Hsu CC, Wang JW, et al. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J, 2008, 31(6): 583-591.
16.	Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
17.	Chiang ER, Su YP, Chen TH, et al. Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty. Acta Orthop, 2011, 82(4): 460-464.
18.	Gooding CR, Masri BA, Duncan CP, et al. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res, 2011, 469(4): 985-993.
19.	蒋垚, 沈灏, 张先龙, 等. 带抗生素可活动关节骨水泥间隔在全膝关节置换术后感染中的应用. 中华骨科杂志, 2006, 26(12): 827-830.
20.	Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg (Am), 2006, 88(11): 2487-2500.
21.	Hofmann AA, Goldberg T, Tanner AM, et al. Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res, 2005, (430): 125-131.
22.	MacAvoy MC, Ries MD. The ball and socket articulating spacer for infected total knee arthroplasty. J Arthroplasty, 2005, 20(6): 757-762.
23.	Ha CW. A technique for intraoperative construction of antibiotic spacers. Clin Orthop Relat Res, 2006, 445: 204-209.
24.	Villanueva-Martínez M, Ríos-Luna A, Pereiro J, et al. Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients. Acta Orthop, 2008, 79(5): 674-682.
25.	Garg P, Ranjan R, Bandyopadhyay U, et al. Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty. Indian J Orthop, 2011, 45(6): 535-540.
26.	Ellenrieder M, Lenz R, Haenle M, et al. Two-stage revision of implant-associated infections after total hip and knee arthroplasty. GMS Krankenhhyg Interdiszip, 2011, 6(1): 1-8.
27.	Laudermilch DJ, Fedorka CJ, Heyl A, et al. Outcomes of revision total knee arthroplasty after methicillin-resistant Staphylococcus aureus infection. Clin Orthop Relat Res, 2010, 468(8): 2067-2073.
28.	Parvizi J, Azzam K, Ghanem E, et al. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res, 2009, 467(7): 1732-1739.
29.	Leung F, Richards CJ, Garbuz DS, et al. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res, 2011, 469(4): 1009-1015.
30.	Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg (Am), 2008, 90(1): 78-84.
31.	Howard JL, Kudera J, Lewallen DG, et al. Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg (Am), 2011, 93(5): 478-484.
32.	Lachiewicz PF, Bolognesi MP, Henderson RA, et al. Can tantalum cones provide fixation in complex revision knee arthroplasty? Clin Orthop Relat Res, 2012, 470(1): 199-204.

1. Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis, 2006, 42(4): 471-478.
2. Salgado CD, Dash S, Cantey JR, et al. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res, 2007, 461: 48-53.
3. Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res, 2008, 466(7): 1710-1715.
4. Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
5. Ong KL, Mowat FS, Chan N, et al. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res, 2006, (446): 22-28.
6. Oduwole KO, Molony DC, Walls RJ, et al. Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 945-948.
7. Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg (Am), 2008, 90(8): 1637-1643.
8. Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
9. Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
10. 史占军, 肖军, 李朋. 人工关节置换术后假体周围感染的诊断. 中华骨科杂志, 2010, 30(6): 626-629.
11. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
12. Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
13. 曹力, 阿斯哈尔江, 张晓岗, 等. 一期翻修术治疗全膝关节置换术后感染. 中华骨科杂志, 2011, 31(2): 131-136.
14. Cordero-Ampuero J, Esteban J, García-Cimbrelo E, et al. Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2-9 years. Acta Orthop, 2007, 78(4): 511-519.
15. Hsu CS, Hsu CC, Wang JW, et al. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J, 2008, 31(6): 583-591.
16. Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
17. Chiang ER, Su YP, Chen TH, et al. Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty. Acta Orthop, 2011, 82(4): 460-464.
18. Gooding CR, Masri BA, Duncan CP, et al. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res, 2011, 469(4): 985-993.
19. 蒋垚, 沈灏, 张先龙, 等. 带抗生素可活动关节骨水泥间隔在全膝关节置换术后感染中的应用. 中华骨科杂志, 2006, 26(12): 827-830.
20. Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg (Am), 2006, 88(11): 2487-2500.
21. Hofmann AA, Goldberg T, Tanner AM, et al. Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res, 2005, (430): 125-131.
22. MacAvoy MC, Ries MD. The ball and socket articulating spacer for infected total knee arthroplasty. J Arthroplasty, 2005, 20(6): 757-762.
23. Ha CW. A technique for intraoperative construction of antibiotic spacers. Clin Orthop Relat Res, 2006, 445: 204-209.
24. Villanueva-Martínez M, Ríos-Luna A, Pereiro J, et al. Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients. Acta Orthop, 2008, 79(5): 674-682.
25. Garg P, Ranjan R, Bandyopadhyay U, et al. Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty. Indian J Orthop, 2011, 45(6): 535-540.
26. Ellenrieder M, Lenz R, Haenle M, et al. Two-stage revision of implant-associated infections after total hip and knee arthroplasty. GMS Krankenhhyg Interdiszip, 2011, 6(1): 1-8.
27. Laudermilch DJ, Fedorka CJ, Heyl A, et al. Outcomes of revision total knee arthroplasty after methicillin-resistant Staphylococcus aureus infection. Clin Orthop Relat Res, 2010, 468(8): 2067-2073.
28. Parvizi J, Azzam K, Ghanem E, et al. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res, 2009, 467(7): 1732-1739.
29. Leung F, Richards CJ, Garbuz DS, et al. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res, 2011, 469(4): 1009-1015.
30. Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg (Am), 2008, 90(1): 78-84.
31. Howard JL, Kudera J, Lewallen DG, et al. Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg (Am), 2011, 93(5): 478-484.
32. Lachiewicz PF, Bolognesi MP, Henderson RA, et al. Can tantalum cones provide fixation in complex revision knee arthroplasty? Clin Orthop Relat Res, 2012, 470(1): 199-204.

Chinese Journal of Reparative and Reconstructive Surgery

TWO-STAGE REVISION OF INFECTED TOTAL KNEE ARTHROPLASTY USING ANTIBIOTIC-IMPREGNATED ARTICULATING CEMENT SPACER

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