| Reinfected revised TKA resolves with an aggressive protocol and antibiotic infusion. | |
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MedLine Citation:
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PMID: 21948323 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Revision of failed two-stage revision TKA for infection is challenging, and amputation often is the only alternative. QUESTIONS/PURPOSES: We asked whether reinfection after two-stage revision for infection could be controlled with an aggressive revision protocol and intraarticular antibiotic infusion. METHODS: We retrospectively reviewed 18 patients (12 women, six men) who underwent revision for failed reimplantation between January 1999 and January 2008. Mean time from revision for infection to rerevision for reinfection was 5 months (range, 1-18 months). All knees were treated with an individualized protocol that included aggressive exposure, extensive débridement, uncemented components, closure with muscle flaps (seven knees) and other plastic surgery procedures (three knees), and direct antibiotic infusion through Hickman catheters for 6 weeks. Ten knees had one-stage revision; five had débridement, cement spacer, and revision surgery 3 to 4 months later; and three had extensive soft tissue reconstruction before revision surgery. The minimum followup was 2.3 years (mean, 6.1 years; range, 2.3-12.0 years). RESULTS: The mean Knee Society scores improved from 33 preoperatively to 76. Seventeen of the 18 had control of infection and achieved durable fixation and a closed wound. One patient had recurrent infection 13 months after one-stage revision, was revised, and remained asymptomatic 28 months postoperatively after redébridement and vancomycin infusion for 6 weeks. In one patient, soft tissue closure was not obtained and the patient required amputation. CONCLUSIONS: Extensile exposure, débridement, and soft tissue flaps for closure combined with uncemented fixation of revision implants and antibiotic infusion into the knee controlled reinfection after revision TKA. |
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Authors:
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Leo A Whiteside; Tariq A Nayfeh; Renee LaZear; Marcel E Roy |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Clinical orthopaedics and related research Volume: 470 ISSN: 1528-1132 ISO Abbreviation: Clin. Orthop. Relat. Res. Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2011-12-15 Completed Date: 2012-08-16 Revised Date: 2013-02-20 |
Medline Journal Info:
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Nlm Unique ID: 0075674 Medline TA: Clin Orthop Relat Res Country: United States |
Other Details:
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Languages: eng Pagination: 236-43 Citation Subset: AIM; IM |
Affiliation:
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Missouri Bone and Joint Center, St Louis, MO, USA. info@mobojo.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anti-Bacterial Agents / administration & dosage* Arthroplasty, Replacement, Knee / adverse effects*, methods Cohort Studies Debridement / methods Female Follow-Up Studies Humans Infusions, Intravenous Injections, Intra-Articular Knee Prosthesis Male Middle Aged Prosthesis-Related Infections / drug therapy*, microbiology, surgery* Recovery of Function Recurrence Reoperation / methods Retrospective Studies Risk Assessment Time Factors Treatment Outcome Vancomycin / administration & dosage |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 1404-90-6/Vancomycin |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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