Clinical and radiological outcomes of second stage revision knee arthroplasty in infected primary knee arthroplasty

Clinical and radiological outcomes of second stage revision knee arthroplasty in infected primary knee arthroplasty. Purpose: To evaluate the clinical and radiological outcomes of two -stage revision knee arthroplasty treatment which is performed in Karadeniz Technichal University, Departments of Orthopaedics between January 2005-January 2019 in infected primary knee arthroplasty. Materials and methods: Patient records were screened from hospital archive, retrospectively. Minimum follow-up period is decided as at least 18 months. 27 patients were included in this study. Physical examination, erythrocyte sedimentation rate, C-reactive protein level, white-blood cell count, aspiration and tissue culture results, radiolographic images were evaluated for the diagnosis of infection. Implant removal, agressive debridement and to place spacers with the antibiotic impregnated cement is performed at the first stage of treatment. After the first stage, patients were used intravenous and oral antibiotic aproximately 6,5 weeks. Specifically, decreased CRP and ESR levels were observed at the follow-up. The patients who had decreased CRP,ESR and WBC levels without using of any antibiotics were underwent to the second stage revision knee arthroplasty surgery. After the all treatment, patients were followed up with the same laboratory parameters. KSS clinical and radiological scores were recorded at the final follow-up. We also compared the results of pain scores(VAS), ROMs and walking distances in preoperatively and postoperatively periods. Results: Nineteen of patients were female, eight of patients were male. The mean patient age was 71,4±6,7. The mean patient follow-up period was 48 months(1439,4 ±18,9 966,8 days). Positive culture results were detected in 16(%59) patients. Coagulase negative staphylococcus was the most isolated microorganism. The mean preoperative and postoperative KSS clinical scores were 43,1 and 54,1 respectively. KSS functional scores were 26,5 and 41,7, respectively. The mean preoperative ROM was 80˚. After operation, the mean ROM increased 90˚. Before treatment, the mean VAS score was 59,3. It decreased 27,6 postoperatively. CRP,WBC and ESR levels decreased significantly at postoperative period. Conclusion: Infection following total knee arthroplasty is the most devastating complication and the treatment can be intractable. Although two stage revision knee arthroplasty is more time-consuming, the better results can be obtained. The results of our study were consistent with the literature. The use of antibiotic cement during the first stage and the addition of extra antibiotics provides ease in infection eradication. Adminstering at least 6 weeks intravenous or oral antibiotic treatment considering culture results, causative microorganisms and the consultations of Infectious Diseases Department is essential to obtain beter results at treatment. Keywords: İnfected Knee Arthroplasty, Two Stage Revision