P Herrmann1, P Thoele, V Heppert. 1. Abteilung Unfall-, Wirbelsäulen- und Gelenkchirurgie, Asklepios-Südpfalzklinik Kandel, Luitpoldstr. 14, 76870 Kandel, Germany. pe.herrmann@asklepios.com
Abstract
OBJECTIVE: Treatment of late and chronic infections, which require the replacement of all the infected implant material. INDICATIONS: All infections lasting more than 4 weeks that have been proven to be bacterial and/or obvious signs of infection. CONTRAINDICATIONS: Unsuitable for anesthesia, high acute infection with sepsis and risk for bacteremia with danger to life, large soft tissue damage where plastic surgery coverage is not possible. SURGICAL TECHNIQUE: Arthrotomy, synovectomy, removal of all foreign bodies including all residue of polymethylmethacrylate (PMMA), jet lavage, spacer, drainage, wound closure or temporary closure using vacuum sealing. POSTOPERATIVE MANAGEMENT: Bed rest with a leg brace and drainage until daily drainage volume is <50 ml, then mobilization with no weight-bearing in an orthesis, 4 weeks systemic antibiotics, after 2 weeks without antibiotics aspiration of the joint, when no bacteria are found reimplantation of a revision TKA (total knee arthroplasty) and with plastic surgery for coverage (gastrognemius flap) if necessary, when bacteria are found again revision with exchange of the spacer. RESULTS: In the literature, the success rate for both the one-stage or the two-stage procedure is about 80-95%. In our very nonhomogeneous collective the overall rate of success is about 81%.
OBJECTIVE: Treatment of late and chronic infections, which require the replacement of all the infected implant material. INDICATIONS: All infections lasting more than 4 weeks that have been proven to be bacterial and/or obvious signs of infection. CONTRAINDICATIONS: Unsuitable for anesthesia, high acute infection with sepsis and risk for bacteremia with danger to life, large soft tissue damage where plastic surgery coverage is not possible. SURGICAL TECHNIQUE: Arthrotomy, synovectomy, removal of all foreign bodies including all residue of polymethylmethacrylate (PMMA), jet lavage, spacer, drainage, wound closure or temporary closure using vacuum sealing. POSTOPERATIVE MANAGEMENT: Bed rest with a leg brace and drainage until daily drainage volume is <50 ml, then mobilization with no weight-bearing in an orthesis, 4 weeks systemic antibiotics, after 2 weeks without antibiotics aspiration of the joint, when no bacteria are found reimplantation of a revision TKA (total knee arthroplasty) and with plastic surgery for coverage (gastrognemius flap) if necessary, when bacteria are found again revision with exchange of the spacer. RESULTS: In the literature, the success rate for both the one-stage or the two-stage procedure is about 80-95%. In our very nonhomogeneous collective the overall rate of success is about 81%.
Authors: Gunnar T R Hischebeth; Sascha Gravius; Johanna K Buhr; Ernst Molitor; Matthias D Wimmer; Achim Hoerauf; Isabelle Bekeredjian-Ding; Thomas M Randau Journal: J Vis Exp Date: 2017-12-03 Impact factor: 1.355