Aim: To review our practice of performing two-stage revision for infected total knee arthroplasty by using articulating interval prosthesis and short course parenteral antibiotic therapy. Patients and Methods: We included 70 patients treated by a single surgeon using a uniform protocol since 2001. All patients were planned to have two- stage revision for infected total knee arthroplasty with an articulating interval prosthesis made up of cruciate retaining femur and all poly tibia at stage one. All patients were given short course parenteral antibiotic therapy (5 days IV) followed by and 6 weeks dual oral therapy. Results: The average age was 68 yrs at the time of first stage. Five patients required repeat of 1st stage procedure because of persistent infection. Twenty six (40%) patients opted not to have a 2nd stage procedure because of eradication of infection after 1st stage and good functional result with interval prosthesis. We had recurrence of infection in 6 patients after two-stage procedure at a mean follow up of 42 months. Four patients out of these six had multiple surgeries for infection before our two-stage protocol. Conclusion: Articulating interval prosthesis gives excellent function and also makes subsequent revision easier with well preserved soft tissue balance. It also takes pressure off on the time constraint for the 2nd stage and good number of them may not require a 2nd stage at all. Our results of recurrence are comparable with published literature evidence and we don’t think that prolonged parenteral antibiotics therapy is required provided adequate surgical debridement has been performed

Aims

Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Two-stage revision has traditionally been considered the gold standard of treatment for established infection, but increasing evidence is emerging in support of one-stage exchange for selected patients. The objective of this study was to determine the outcomes of single-stage revision TKA for PJI, with mid-term follow-up.

Introduction: One stage and two stage exchange procedures are acknowledged as gold standard for revision surgery in periprosthetic infection. Since the one stage concept is ethically, medically and economically superior, the last necessary argument is a fair rate of success on a large scale. The two stage procedure could then be limited to its genuine indications only. Material and Methods: In three years (2005/06/07) 555 one stage exchanges of the hip and the knee were carried out at our clinic. A first homogenous group of 282 cases has now been analysed and followed-up. Detailed data regarding case history, clinical situation, treatment course and complications will be presented. All cases were investigated through a telephone protocol or examination on an outpatient basis by the same person. The group contained 180 hips and 102 knees. The median age was 68, (22/91). The median follow-up time was 31 months, (51/15). Results: The primary success rate (dismissal from hospital) was 99% (1 death, 1 disarticulation). The revised rate of success in the course of the follow-up was 92,7 %. Conclusion: With a success rate of 92,7 % this example of the one stage performance proves the standard realisation possibility of this concept. Advantages like no impairment in the interval without prosthesis, reduced complication and risk possibilities and reduced costs speak for this procedure. Nevertheless prerequisites have to be respected. But after all the one stage procedure should be made available to all patients with the appropriate indication