Retention of the components with debridement and antibiotic suppression in the treatment of infected total knee arthroplasty

Abstract

The optimum treatment of infected total knee arthroplasty remains complex and controversial. Treatment alternatives for the infected total knee arthroplasty (TKA) include antibiotic suppression alone, debridement combined with administration of antibiotics, reimplantation, resection arthroplasty, arthrodesis, and amputation. Total knee arthroplasties in which an acute infection has developed but in which the components are still well fixed may be treated with aggressive debridement and antibiotics. This option for salvage of infected total knee arthroplasty has not been very effective and indications are limited. Seven total knee arthroplasties were followed by infection in seven patients who were subsequently treated with debridement, retention of the components and administration of antibiotics. The average age of the patients at the time of infection was 65.2 (59-70) years. The average duration of follow-up was 28.8 (12-34) months. Infection had recurred in 4 patients. Three of them have been treated with two stage and one of them has been treated with one stage reimplantation. At the most recent follow-up all knes remained free of infection. In conclusion the low rate of success was dissappointing. It is appearent that strict criteria must be met before this approach is used.

Özet

İnfekte total diz artroplastisinde debridman + antibiyotik supresyonu çok sınırlı endikasyonlarda uygula-nabilen bir tedavidir. Çalışmamızda kliniğimizde infekte total diz artroplastisi nedeniyle bu tekniği uyguladığımız 7 hastanın sonuçlarını değerlendirdik. Hastalarımızın ortalama yaşı 65.2 (59-70) yıl, ortalama takip süresi 28.8 (12-34) ay olarak bulundu. Takiplerinde hastaların 4 ünde (%57) reinfeksiyon gelişti. Bunların 3 üne iki aşamalı 1 ine ise tek aşamalı reimplamasyon uygulandı. Sınırlı sayıdaki tecrübemize karşın debridman + antibiyotik supresyonu tekniği ile yapılan revizyon sonuçlarımız yüz güldürücü değildir. Bu nedenle endikasyon için gerekli tüm koşullar bulunmadıkça bu yöntemin kullanılmasını önermemekteyiz.