Abstract
Aims: The purpose of this study was to review the success rates of a new management strategy when dealing with deep infection in knee arthroplasty.
Methods: Since 1998 a management plan consisting of an initial debridement, insertion of vancomycin loaded prostolac spacers and 2 weeks of intravenous antibiotics has been used. If inflammatory indices are improved at 12 weeks reimplantation occurs with antibiotic treatment until cultures are completed. The necessary data has been prospectively collected and reviewed to identify predictors of success.
Results: 34 patients have been identified with a minimum of 12 months follow up. 27 of these have at least 24 months follow up. With an endpoint of a functioning prosthesis clear of infection we have achieved an 82% success rate. If the inflammatory indices and frozen section were normal at the time of reimplantation this was 90% predictive of a successful outcome. Although 13 patients had a combination of abnormal blood tests, cultures and frozen sections at the time of reimplantation only 4 of these went on to develop recurrent infection. 2 patients with normal investigations at reimplantation went on to demonstrate residual infection.
Conclusion: Short courses of parenteral treatment can produce comparable results to previously published series when treating deep infection after knee replacement. Allowing weight bearing and range of motion exercise does not appear to hamper the eradication of infection. None of the investigations currently employed have been shown to be 100% reliable in this series of cases. Whilst attention to detail and careful planning are pre-requisites for this surgery one still has to prepared for failure.
The abstracts were prepared by Mr Roger Smith. Correspondence should be addressed to him at the British Association for Surgery of the Knee, c/o BOA, Royal College of Surgeons of England, 35–43 Lincoln’s Inn Fields, London WC2A 3PN.
