Two-stage Revision of Infected Total Knee Arthroplasty Using an Antibiotic-impregnated Static Cement-spacer

Background: Static antibiotic-impregnated cement spacers have been used widely to treatchronically infected total knee arthroplasties with a high success result.However, difficulty in surgical exposure during revision has been encountered.The purpose of this study was to evaluate the clinical results of twostagereimplantation of an infected total knee arthroplasty using a staticantibiotic-impregnated cement spacer.Methods: Thirty-one patients (32 knees) with infected total knee arthroplasty had atwo-stage reimplantation using a static antibiotic-impregnated cement spacer.Twelve (37.5%) of 32 knees required a V-Y quadricepsplasty and five(15.6%) required a quadriceps snip for surgical exposure at revision. Onepatient was lost to follow-up and three patients died of unrelated causes. Theremaining 27 patients (28 knees) returned at a mean of 68.3 months (8-197months) for clinical evaluation.Results: Four knees (14%) had recurrent infection. The mean Knee Society scoreimproved from 40 points preoperatively to 82 points postoperatively. Themean functional score improved from 10 points preoperatively to 60 pointspostoperatively. The mean range of knee motion improved from 57° preoperativelyto 88° at the latest follow-up. Three knees with V-Y quadricepsplastydeveloped an extension lag from 20° to 45° and three knees had a patellabaja postoperatively.Conclusion: Two-stage reimplantation of an infected total knee arthroplasty using a staticantibiotic-cement spacer achieved an infection control rate of 86% andimprovement in the clinical results. However, weakness of the extensormechanism of the knee associated with a V-Y quadricepsplasty, which wasrequired in a high percentage of patients during revision surgery in ourseries, is of great concern.