To improve the challenging treatment of periprosthetic joint infections (PJI), researchers are constantly developing new handling methods and strategies. In patients with PJI after total knee arthroplasty (TKA) and severe local or systemic comorbidities, a two-stage exchange using a temporary antibiotic loaded PMMA-spacer is considered gold standard. This method has undisputed advantages, however, the increased risk of biofilm formation on the spacer surface, bone defects and soft tissue contractions after a six-week spacer interval are severe limitations. Our hypothesis is that a vacuum sealed foam in combination with constant instillation of an antiseptic fluid can address these drawbacks due to a significantly reduced spacer interval. A pilot study was conducted in five PJI cases after TKA with severe comorbidities and/or multiple previous operations to evaluate the feasibility and safety of the proposed method. In the first step, surgical treatment included the explantation of the prosthesis, debridement, and the implantation of the VeraFlo-Dressing foam. The foam is connected to the VAC-Instill-Device via an inflow and an outflow tube. The surgical site is sealed airtight with the VAC-film. During the next 5 days, an antiseptic fluid (Lavasorb® or Taurolidine®) is instilled in a 30-minute interval using the VAC-Instill-Device. The limb is immobilized (no flexion in the knee joint, no weight bearing) for five days. Following that, the second operation is performed in which the VAC-VeraFloTM-Therapy System is explanted and the revision TKA is implanted after debridement of the joint.Aim
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