Outcome of total knee replacement following explantation and cemented spacer therapy

• Main Authors: Ghanem, Mohamed, Zajonz, Dirk, Bollmann, Juliane, Geissler, Vanessa, Prietzel, Torsten, Moche, Michael, Roth, Andreas, Heyde, Christoph-E., Josten, Christoph
• Format: Article
• Language: deu
• Published: German Medical Science GMS Publishing House 2016-03-01
• Series: GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW
• Subjects: periprosthetic infection; endoprosthesis infection; cemented spacer therapy; total knee replacement
• Online Access: http://www.egms.de/static/en/journals/iprs/2016-5/iprs000091.shtml

Background: Infection after total knee replacement (TKR) is one of the serious complications which must be pursued with a very effective therapeutic concept. In most cases this means revision arthroplasty, in which one-setting and two-setting procedures are distinguished. Healing of infection is the conditio sine qua non for re-implantation. This retrospective work presents an assessment of the success rate after a two-setting revision arthroplasty of the knee following periprosthetic infection. It further considers drawing conclusions concerning the optimal timing of re-implantation.Patients and methods: A total of 34 patients have been enclosed in this study from September 2005 to December 2013. 35 re-implantations were carried out following explantation of total knee and implantation of cemented spacer. The patient’s group comprised of 53% (18) males and 47% (16) females. The average age at re-implantation time was 72.2 years (ranging from 54 to 85 years). We particularly evaluated the microbial spectrum, the interval between explantation and re-implantation, the number of surgeries that were necessary prior to re-implantation as well as the postoperative course. Results: We reported 31.4% (11) reinfections following re-implantation surgeries. The number of the reinfections declined with increasing time interval between explantation and re-implantation. Patients who developed reinfections were operated on (re-implantation) after an average of 4.47 months. Those patients with uncomplicated course were operated on (re-implantation) after an average of 6.79 months. Nevertheless, we noticed no essential differences in outcome with regard to the number of surgeries carried out prior to re-implantation. Mobile spacers proved better outcome than temporary arthrodesis with intramedullary fixation.Conclusion: No uniform strategy of treatment exists after peri-prosthetic infections. In particular, no optimal timing can be stated concerning re-implantation. Our data point out to the fact that a longer time interval between explantation and re-implantation reduces the rate of reinfection. From our point of view, the optimal timing for re-implantation depends on various specific factors and therefore it should be defined individually.