Document Detail


Reinfected revised TKA resolves with an aggressive protocol and antibiotic infusion.
MedLine Citation:
PMID:  21948323     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Leo A Whiteside; Tariq A Nayfeh; Renee LaZear; Marcel E Roy
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  470     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-15     Completed Date:  2012-08-16     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  236-43     Citation Subset:  AIM; IM    
Affiliation:
Missouri Bone and Joint Center, St Louis, MO, USA. info@mobojo.org
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MeSH Terms
Descriptor/Qualifier:
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:
0/Anti-Bacterial Agents; 1404-90-6/Vancomycin
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