38 total knee replacements (in 35 patients) that were complicated by infection were treated with a 2-stage protocol for reimplantation. The clinical results in these knees (9 of which have been previously reported on) were evaluated at an average follow-up of 4 years (range, 2.5 to 10 years). There was only one documented recurrence of infection with the original organism. 3 patients in whom the immunological system was suppressed had a subsequent hematogenous infection with a different organism. According to the knee-rating system of The Hospital for Special Surgery, there were 11 excellent, 13 good, 6 fair, and 7 poor results. For one patient who had severe polyarticular rheumatoid arthritis, the result could not be rated. The results of this study suggested that the 2-stage protocol for reimplantation, with a 6-week interval of intravenous antibiotic therapy, is the procedure of choice for the treatment of an infection around a total knee arthroplasty. A patient who has polyarticular rheumatoid arthritis and in whom the immunological system is suppressed may not be an ideal candidate for the protocol. Gram-negative bacterial infection may be treated with this protocol, provided the organism is sensitive to relatively non-toxic antibiotic medication.
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38 total knee replacements (in 35 patients) that were complicated by infection were treated with a 2-stage protocol for reimplantation. The clinical results in these knees (9 of which have been previously reported on) were evaluated at an average follow-up of 4 years (range, 2.5 to 10 years). There was only one documented recurrence of infection with the original organism. 3 patients in whom the immunological system was suppressed had a subsequent hematogenous infection with a different organism. According to the knee-rating system of The Hospital for Special Surgery, there were 11 excellent, 13 good, 6 fair, and 7 poor results. For one patient who had severe polyarticular rheumatoid arthritis, the result could not be rated. The results of this study suggested that the 2-stage protocol for reimplantation, with a 6-week interval of intravenous antibiotic therapy, is the procedure of choice for the treatment of an infection around a total knee arthroplasty. A patient who has polyarticular rheumatoid arthritis and in whom the immunological system is suppressed may not be an ideal candidate for the protocol. Gram-negative bacterial infection may be treated with this protocol, provided the organism is sensitive to relatively non-toxic antibiotic medication.
Copyright remains with the authors and publisher.