Two-Stage Reimplantation in Infected Total Knee Arthroplasty

Knee Surgery & Related Research
Yong Seuk Lee, Antonia F Chen

Abstract

Two-stage reimplantation is considered the gold standard for the management of periprosthetic joint infection. The first stage involves the removal of the prosthesis, followed by extensive debridement of all nonviable tissues, synovectomy, irrigation, and reaming of the medullary canals. Once the joint has been prepared, antibiotic-impregnated cement beads and/or spacer are inserted. Antibiotic-impregnated spacers are now more commonly used, and an increasing number of orthopaedic surgeons are using articulating spacers if indicated. Antibiotics are then prescribed to the patient based on the sensitivities of the infecting organism. The duration of systemic antibiotic use is decreasing, and short courses of antibiotic therapy have been shown to be as efficacious as prolonged therapy between the first and second stages. The second stage of the procedure involves removal of the antibiotic-impregnated cement beads and/or spacer, repeat irrigation and debridement, and final reconstruction with revision components. While two-stage reimplantation was considered the gold standard in many parts of the world, recent studies have demonstrated that it is associated with a considerable failure rate. This may be due to the lack of accurate ...Continue Reading

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Citations

Oct 15, 2019·The Journal of Bone and Joint Surgery. American Volume·Linsen T SamuelAtul F Kamath
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Jul 15, 2020·Knee Surgery & Related Research·Du-Han KimByung-Chan Choi
Aug 20, 2021·BMC Musculoskeletal Disorders·Charles OkaforJoshua Byrnes

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Methods Mentioned

BETA
amputations
lavage
ESR

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