High-dose antibiotic infusion for infected knee prosthesis without implant removal

Retention of a prosthesis represents an attractive surgical modality for the infected but well-fixed knee prosthesis because patients need to stay in bed after removal of all components. Some additional postoperative treatment would be needed, however, when treated only with débridement because of i...

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Veröffentlicht in:Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2010-07, Vol.15 (4), p.470-476
Hauptverfasser: Fukagawa, Shingo, Matsuda, Shuichi, Miura, Hiromasa, Okazaki, Ken, Tashiro, Yasutaka, Iwamoto, Yukihide
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container_end_page 476
container_issue 4
container_start_page 470
container_title Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
container_volume 15
creator Fukagawa, Shingo
Matsuda, Shuichi
Miura, Hiromasa
Okazaki, Ken
Tashiro, Yasutaka
Iwamoto, Yukihide
description Retention of a prosthesis represents an attractive surgical modality for the infected but well-fixed knee prosthesis because patients need to stay in bed after removal of all components. Some additional postoperative treatment would be needed, however, when treated only with débridement because of its low success rate. In this study, intraarticular antibiotic infusion into the infected joints after débridement, while retaining the implants, was performed for six well-fixed total knee arthroplasties (TKAs), one revision TKA, and five tumor megaprostheses with an average follow-up period of 47.5 months (range 20–82 months). TKA patients with a polyethylene insert or those with all exchangeable components and all polyethylene parts in tumor megaprostheses underwent device removal and thorough débridement of the soft tissues. Subsequently, new polyethylene inserts were implanted in the TKA patients. The removed metallic prostheses were resterilized and reimplanted, and new polyethylene inserts were implanted in the tumor megaprostheses patients. The wound was closed in layers after insertion of a catheter percutaneously. The patients received organism-specific intraarticular antibiotics through the catheter twice a day until the infection disappeared clinically. There was no recurrence of infection in the TKA and revision TKA patients. Four of five knees treated with tumor megaprostheses exhibited recurrence of the infection. Infection was finally healed, however, in all cases by the same treatment procedure. Although some patients experienced recurrence of infection, successful implant salvage was achieved in all cases with the same treatment procedure. Patients do not need to stay in bed during this treatment. Therefore, this method should be considered as one of the treatment options for infected knee prostheses.
doi_str_mv 10.1007/s00776-010-1487-8
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Some additional postoperative treatment would be needed, however, when treated only with débridement because of its low success rate. In this study, intraarticular antibiotic infusion into the infected joints after débridement, while retaining the implants, was performed for six well-fixed total knee arthroplasties (TKAs), one revision TKA, and five tumor megaprostheses with an average follow-up period of 47.5 months (range 20–82 months). TKA patients with a polyethylene insert or those with all exchangeable components and all polyethylene parts in tumor megaprostheses underwent device removal and thorough débridement of the soft tissues. Subsequently, new polyethylene inserts were implanted in the TKA patients. The removed metallic prostheses were resterilized and reimplanted, and new polyethylene inserts were implanted in the tumor megaprostheses patients. The wound was closed in layers after insertion of a catheter percutaneously. 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subjects Adult
Aged
Anti-Bacterial Agents - administration & dosage
Arthroplasty, Replacement, Knee - adverse effects
Debridement
Dose-Response Relationship, Drug
Female
Humans
Infusions, Intra-Arterial
Knee Prosthesis - adverse effects
Male
Medicine
Medicine & Public Health
Middle Aged
Original Article
Orthopedics
Prosthesis-Related Infections - drug therapy
Recovery of Function
Rheumatology
Young Adult
title High-dose antibiotic infusion for infected knee prosthesis without implant removal
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