Reinfected Revised TKA Resolves With an Aggressive Protocol and Antibiotic Infusion

Abstract

Background Revision of failed two-stage revision TKA for infection is challenging, and amputation often is the only alternative. Questions/purposes We asked whether reinfection after two-stage revision for infection could be controlled with an aggressive revision protocol and intraarticular antibiotic infusion. Methods We retrospectively reviewed 18 patients (12 women, six men) who underwent revision

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

“…The a priori power analysis was based on the question whether a TTO or QS would result in a superior KSS [53] of at least 20 points in two-stage RTKAs for prosthetic knee infections. Two-stage RTKAs for prosthetic knee infections have reported rates of infection control between 80% and 96% [17,39,42,45,46,50,64,68,84,100]. If a mean reinfection rate is 10% and a difference of 5% would be clinically meaningful, 450 patients per group would reach a power of at least 80% with a CI of 95%.…”

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

“…Antibiotic-impregnated cement spacers achieve local concentrations of vancomycin over 1500 lg/ mL (three orders of magnitude greater than the MIC for planktonic forms) during the first few days after surgery, but those levels decrease rapidly during the succeeding days [2,22]. In contrast, direct antibiotic infusion through a catheter, as first described by Perry et al, achieves extremely high local levels of antibiotics for a prolonged period of time [44,46,[54][55][56] and can be discontinued if toxicity or sensitivity occurs [55]. This method has been effective in treating infected TKA in challenging conditions [54][55][56], and use of a cannulated spacer for delivering antibiotics into an infected total hip after débridement has been reported with successful early results [25].…”

“…In contrast, direct antibiotic infusion through a catheter, as first described by Perry et al, achieves extremely high local levels of antibiotics for a prolonged period of time [44,46,[54][55][56] and can be discontinued if toxicity or sensitivity occurs [55]. This method has been effective in treating infected TKA in challenging conditions [54][55][56], and use of a cannulated spacer for delivering antibiotics into an infected total hip after débridement has been reported with successful early results [25]. However, that report described a temporary spacer that required subsequent removal to prepare for the final implant.…”

“…Single-stage revision arthroplasty combined with local antibiotic infusion has been described fairly extensively for TKA [54][55][56], but this procedure has not been described in detail for THA. Because two-stage revision involves two major operations, and antibiotic spacers themselves may create complications, a procedure that could obviate both the second stage and the spacers, while producing very high antibiotic concentration that could be continued for weeks, would be advantageous.…”

CORR Insights®: One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

“…The use of a Hickman catheter to treat infected TKA patients was first described in 2011, and reported a 94% success rate based on infection recurrence [13][14][15]. The benefit of this delivery method is that antibiotic delivery can be continuously administered.…”