Two-stage Reimplantation in Infected Total Knee Arthroplasty by Using Resterilized Femoral and Tibial Components with a New Polyethylene Insert: Report of 4 Cases with at Least 15 Years’ Follow-up

2021 ◽  
Vol 23 (6) ◽  
pp. 411-416
Author(s):  
Alpaslan Öztürk ◽  
Nazan Çevik ◽  
Yavuz Akalın ◽  
Oğuz Çetin ◽  
Özgür Avci( ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Periprosthetic Infection ◽  
Polyethylene Insert ◽  
Two Stage ◽  
Second Stage ◽  
Articulating Spacer ◽  
Total Knee

Background. This study evaluates 15 years’ results of the implantation of autoclaved femoral and tibial prosthesis components together with a new same brand polyethylene insert which were used as a temporary articulating spacer in patients with periprosthetic infection of total knee arthroplasty (TKA) in a two-stage reimplantation procedure in 6 patients.  Material and methods. The femoral and tibial prostheses of 6 patients with deep chronic periprosthetic infection of TKA who underwent elective two-stage exchange arthroplasty were autoclaved and reinserted with a new polyethylene insert of the same brand and bone cement mixed with tecoplanin in 2004. Results. Four patients were followed for 15 years. They were all female and between 47-70 years old. The infectious agent was meticillin-resistant Staphylococcus aureus (MRSA) in 3 and coagulase negative Staphy­lococcus in one patient. Patients were invited for second stage reimplantation, but they refused to undergo the second stage. Three of them had their second stage reimplantation after 15, 13 and 10 years while one patient was reinfected after 5 years, in 2009, and arthrodesis was performed. They were all happy with the result and infection free at last follow-up.  Conclusions. 1. Regarding the results of our patients, reinsertion of autoclaved femoral and tibial prostheses together with a new same brand polyethylene insert with teicoplanin loaded bone cement can be used cautiously in the management of periprosthetic deep infection of TKA. 2. That is because patients might not want the second stage reimplantation. 3. We believe that the refusal of patients to undergo the surgery shows that the single-stage treatment is effective.

Flash Sterilization and Component Reimplantation Is a Viable Option for Articulating Antibiotic Spacers in Periprosthetic Knee Infections

2020 ◽  
Author(s):  
Vasili Karas ◽  
Richard W. Rutherford ◽  
Thomas A. Herschmiller ◽  
Johannes F. Plate ◽  
Michael P. Bolognesi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Two Stage ◽  
Infected Total Knee Arthroplasty ◽  
Articulating Spacer ◽  
Total Knee ◽  
Antibiotic Spacer

AbstractThe articulating antibiotic spacer is a treatment utilized for two-stage revision of an infected total knee arthroplasty. The original femoral component is retained and reused in one described variation of this technique. The purpose of this study is to determine the safety and efficacy of flash sterilization of the femoral component for reimplantation in an articulating antibiotic spacer for the treatment of chronic periprosthetic joint infection. A total of 10 patients were identified prospectively with a culture positive infected total knee arthroplasty. The patients underwent explantation, debridement, and placement of an articulating antibiotic spacer consisting of the explanted and sterilized femoral component and a new polyethylene tibial insert. The explanted tibial components were cleaned and flash-sterilized with the femoral components, but the components were then aseptically packaged and sent to our microbiology laboratory for sonication and culture of the sonicate for 14 days. Ten of 10 cleaned tibial components were negative for bacterial growth of the infecting organism after final testing and analysis. At 18-month follow-up, 9 of 10 of patients remained clear of infection. Among the 10 patients, 7 were pleased with their articulating spacer construct and had no intention of electively pursuing reimplantation. Also, 3 of 10 of patients were successfully reimplanted at a mean of 6.5 months after explantation. Autoclave sterilization and reimplantation of components may be a safe and potentially resource-sparing method of articulating spacer placement in two-stage treatment of PJI. Patient follow-up demonstrated clinical eradication of infection in 90% of cases with good patient tolerance of the antibiotic spacer.

scholarly journals Survival rate after septic total knee arthroplasty- a comparison of two treatment algorithms

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0014
Author(s):  
Clemens Baier ◽  
Günther Maderbacher ◽  
Joachim Grifka ◽  
Hans-Robert Springorum
Keyword(s):  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Persistent Infection ◽  
Tissue Samples ◽  
Articulating Spacer ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Aims and Objectives: To date there exists no golden standard of treatment of late periprosthetic joint infection. Different forms of treatment comprise single-stage or two-stage or multiple revisions. Respectively, mid- to long-term results are rare. Materials and Methods: We retrospectively analysed 66 patients with septic total knee arthroplasty treated by two different therapy algorithms: Until 2009 patients were treated routinely by implant removal and implantation of an articulating spacer in combination with at least 6 weeks of antibiotic administration. After an antibiotic-free period of two weeks persistent infection was ruled out by punctation. In case of negative antimicrobial cultures after another 14 days patients were treated by reimplantation (n=36, group 1). After 2009 persistent infection was ruled out by open revision and change of the articulating spacer instead of a punctuation. In case of negative antimicrobial cultures after another 14 days patients were treated by reimplantation (n=30, group 2). After a follow-up of 61 months (group 1), respectively 36 months (group 2), patients and their family doctors were contacted by phone concerning the survival rate of the new implant. Results: In group 1 persistent infection was ruled out in every patient by punctuation. During reimplantation tissue samples of 8 patients (22%) showed positive microbiological results again, within 4 patients with a change of the underlying bacteria. After a follow-up of 61 months 31 patients showed no signs of reinfection of their implant and were not operatively revised (86%). In group 2 all patients were treated with open revision and change of the articulating spacer for at least once. 8 patients showed a change of the underlying bacteria during these procedures. During reimplantation tissue samples of 8 patients (27%) showed positive microbiological results again. After a follow-up of 36 months 27 patients showed no signs of reinfection of their implant and were not operatively revised (90%). The difference between both groups was not significant (p>0.05). Concerning the overall complication rate no significant differences between both groups could be found (p>0.05). Conclusion: Concerning reinfection rate we could not detect significant differences between both groups. Patients of group 2 were treated operatively significantly more often and showed a significantly more frequent change of the underlying bacteria. If these results are confirmed in big cohort studies the elaborate treatment algorithm of open revision and change of the articulating spacer might become dispensable.

scholarly journals Two-Stage Revision Using a Modified Articulating Spacer in Infected Total Knee Arthroplasty

2013 ◽  
Vol 25 (4) ◽  
pp. 180-185 ◽  
Author(s):  
Young Soo Kim ◽  
Ki Cheor Bae ◽  
Chul Hyun Cho ◽  
Kyung Jae Lee ◽  
Eun Seok Sohn ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Two Stage ◽  
Infected Total Knee Arthroplasty ◽  
Articulating Spacer ◽  
Total Knee

scholarly journals Antibiotic-Loaded Bone Cement in Prevention of Periprosthetic Joint Infections in Primary Total Knee Arthroplasty: A Register-based Multicentre Randomised Controlled Non-inferiority Trial (ALBA trial)

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041096
Author(s):  
Tesfaye H Leta ◽  
Jan-Erik Gjertsen ◽  
Håvard Dale ◽  
Geir Hallan ◽  
Stein Håkon Låstad Lygre ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Current Evidence ◽  
Joint Infections ◽  
Total Knee ◽  
Randomised Controlled ◽  
Primary Total Knee

IntroductionThe current evidence on the efficacy of antibiotic-loaded bone cement (ALBC) in reducing the risk of periprosthetic joint infections (PJI) after primary joint reconstruction is insufficient. In several European countries, the use of ALBC is routine practice unlike in the USA where ALBC use is not approved in low-risk patients. Therefore, we designed a double-blinded pragmatic multicentre register-based randomised controlled non-inferiority trial to investigate the effects of ALBC compared with plain bone cement in primary total knee arthroplasty (TKA).Methods and analysisA minimum of 9,172 patients undergoing full-cemented primary TKA will be recruited and equally randomised into the ALBC group and the plain bone cement group. This trial will be conducted in Norwegian hospitals that routinely perform cemented primary TKA. The primary outcome will be risk of revision surgery due to PJI at 1-year of follow-up. Secondary outcomes will be: risk of revision due to any reason including aseptic loosening at 1, 6, 10 and 20 years of follow-up; patient-related outcome measures like function, pain, satisfaction and health-related quality of life at 1, 6 and 10 years of follow-up; risk of changes in the microbial pattern and resistance profiles of organisms cultured in subsequent revisions at 1, 6, 10 and 20 years of follow-up; cost-effectiveness of routine ALBC versus plain bone cement use in primary TKA. We will use 1:1 randomisation with random permuted blocks and stratify by participating hospitals to randomise patients to receive ALBC or plain bone cement. Inclusion, randomisation and follow-up will be through the Norwegian Arthroplasty Register.Ethics and disseminationThe trial was approved by the Western Norway Regional Committees on Medical and Health Research Ethics (reference number: 2019/751/REK vest) on 21 June 2019. The findings of this trial will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberNCT04135170.

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