Abstract
Introduction: Periprosthetic infection with extensive bone loss is a complex situation. The appropriate management of large bone defects has not been established. Without reconstruction amputation/disarticulation is the likely outcome.
Aim: To Analyse preliminary results of direct exchange endoprosthetic reconstruction for periprosthetic knee infection associated with segmental bone defects.
Methods: Study of patients with periprosthetic knee infection and severe osteolysis treated by direct exchange tumour prostheses between June, 2005 and May, 2008 (4 - Distal femoral & 2 - Total femoral Replacements). Exclusion criteria included polymicrobial infection, resistant organisms, depressed immunity and poor peripheral perfusion. At each clinical visit they were monitored for clinical, microbiological, haematological and radiological evidence of infection. Community based antibiotic therapy was provided by specialist microbiologists. All patients were counselled and consented by the operating surgeon and specialist microbiologist prior to surgery.
Results: The mean age and follow up were 70.2 years and 30.5 months respectively. The most common infecting organism was Staphylococcus epidermidis (four), followed by Streptococcus species. Mean duration of antibiotics was 6 weeks intravenous(community based) and 8 weeks oral. 1 patient required intervention by plastic surgeons at index procedure. Radiographs showed no changes at final followup. One patient had superficial wound infection, which was successfully debrided. Knee range of movements averaged full extension to 95 degrees. The mean oxford knee scores pre and post operatively were 58 and 39.4 respectively.
Conclusion: Salvage direct exchange endoprosthetic reconstruction has provided effective pain relief, stability and improved mobility in our experience. Isolation of sensitive organism, specialist microbiologist input, availability of specialist physiotherapy and plastic surgery service, appropriate community care, good patient compliance and surgeon’s experience are key to success in these patients. Morbidity was significantly reduced due to early mobilisation.
Correspondence should be addressed to: BASK c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
