Two-stage Reimplantation without Cement Spacer

Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan. Received: 27 June 2002 Revised: 29 July 2002 Accepted: 5 November 2002 Reprint requests and correspondence to: Ching-Chuan Jiang, Department of Orthopedic Surgery, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei 100, Taiwan. Background and Purpose: The management of an infected total knee implant is a major challenge to the orthopedic surgeon. We report the outcome using two-stage reimplantation without cement spacers between stages. Methods: Seven infected total knee replacements (TKR) were treated with the two-stage reimplantation technique from September 1994 through January 2001. Treatment of these patients consisted of thorough debridement and removal of the implants. No antibiotic-impregnated cement blocks or beads were inserted and only a long leg cylinder cast was applied for immobilization between stages. Intravenous antibiotics were used and C-reactive protein (CRP) values were monitored. All of the patients were free of infection and revision TKR was performed without using antibiotic-impregnated cement for fixation at an average interval of 6.3 weeks (range 6–10 weeks). Results: The average length of follow-up was 3.5 years (range 1–7 years) and the average HSS (Hospital for Special Surgery) knee score was 86 points (range 78–94). A good result was obtained in one patient and excellent results in six patients. Average range of motion was 91° (range 80°–100°). No recurrence of infection was noted. Conclusions: Two-stage reimplantation without using a cement spacer between stages for septic total knee replacement is tolerable for patients, simpler for surgeons and can achieve good results without recurrence of infection.