Treatment of infected total knee arthroplasty

The 2-5-year results for the treatment of deep infection of total knee arthroplasty (TKA) after two-stage reimplantation are presented. An articulating temporary antibiotic spacer prosthesis (TASP) and a standardized antibiotic regimen were used. In a prospective study, 33 consecutive patients were treated with TASP. This articulating spacer was made on the table by cleaning and autoclaving removed parts of the TKA. Intravenous double antibiotic therapy in combination with rifampin was given for 10 days, followed by oral therapy for 4 weeks. At a mean follow-up period of 47 months (31-67), three patients had reinfection (success rate 91%). The average Hospital for Special Surgery knee score increased from 67 points (44-84) to 85 points (53-97) after reimplantation. Based on these results, 24 knees (73%) were rated excellent, five (15%) were rated good, three (9%) were rated fair, and one patient (3%) had a poor result. Complications included one case of temporary peroneal palsy, one dislocation of the spacer due to an insufficient extensor mechanism, and one fracture of the tibia due to substantial primary metaphyseal bone loss. Using TASP, the disadvantages of joint fixation between the two stages could be reduced. There was no difference in the reinfection rate compared with procedures using fixed spacer blocks. TASP facilitates reimplantation and yields good functional results.