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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
UPDATES ON KNEE ARTHROPLASTY 102nd CONGRESS OF THE PIEMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (S.P.L.L.O.T.) - Brescia September 9-10, 2005
NEW TECHNOLOGIES, MODERN INSTRUMENTARIUM IN ARTHROPLASTIC SURGERY
Minerva Ortopedica e Traumatologica 2005 August;56(4):293-7
The rationale for the management of infected total knee replacements
Mora R. 1, Pedrotti L. 1, Bertani B. 1, Tuvo G. 1, Maccabruni A. 2
1 Clinica Ortopedica e Traumatologica Università degli Studi di Pavia Polo Universitario Città di Pavia, Pavia
2 Clinica delle Malattie Infettive Università degli Studi di Pavia I.R.C.C.S. Policlinico San Matteo, Pavia
Aim. Infection is one of the major complications of a total knee arthroplasty and can be associated with implant failure; its incidence varies from less than 1% to over 10%. In the diagnosis of late infections, clinical presentation, laboratory studies and instrumental findings are rarely helpful, and cultures of the bone and synovial biopsy are the most reliable tests in order to make an aetiological diagnosis. The goal in the treatment is prosthesis exchange after control or eradication of the infection, resulting in a functional knee without sepsis. There are few acceptable management options, at the extremes of which are antibiotics alone or amputation, but the treatment protocols most commonly used are the removal of the implant followed by arthrodesis or by 1 stage or 2 stage reimplantation.
Methods. Ten cases of infected total knee arthroplasty were treated over a five-year period from 1998 to 2003 at the Department of Orthopaedics and Traumatology of the University of Pavia (Città di Pavia Institute). Arthrodesis or two-stage reimplantation were performed in 80% of the cases.
Results. Results were good, especially in cases treated with delayed exchange arthroplasty and the use of an external fixator or an implant of an antibiotic-impregnated polymethylmethacrylate spacer block during the exchange interval.
Conclusion. This technique appears to be a valid salvage option in the approach to infected total knee replacements.