Hofmann A A, Kane K R, Tkach T K, Plaster R L, Camargo M P
Department of Orthopedics, University of Utah Medical Center, Salt Lake City 84132, USA.
Clin Orthop Relat Res. 1995 Dec(321):45-54.
Twenty-six patients with late infected total knee arthroplasties were treated by debridement and removal of components and all cement, preserving collateral ligaments. At time of debridement, an articulating spacer was fashioned to allow partial weightbearing and knee range of motion (ROM) during rehabilitation. This spacer was implanted using antibiotic-impregnated bone cement. For this purpose, 4.8 g of powdered tobramycin was mixed with each 40-g batch of Simplex cement. Cement was applied early to the components, but applied late to the femur, tibia, and patella to allow molding to the defects and bone without adherence to bone. Patients received tailored intravenous antibiotic therapy for 6 weeks in addition to this antibiotic-impregnated cement for treatment of a variety of gram positive and gram negative organisms. All patients had cemented revision total knee arthroplasty using antibiotic-impregnated cement with standard cementing techniques used. All patients but 1 had reimplantation; this patient died of unrelated causes before revision. Range of motion before revision was 10 degrees to 95 degrees. Followup averaged 30 months (range, 13-70 months). The average Modified Hospital for Special Surgery Knee Score after revision was 87 points (range, 53-100 points), with 92% good to excellent results. Range of motion after reimplantation was 5 degrees to 106 degrees. There have been no recurrences of infection. Use of an articulating spacer to treat infected total knee arthroplasty improves ultimate ROM and soft tissue health and significantly decreases the risk of reinfection.
26例晚期感染性全膝关节置换患者接受了清创术，去除假体组件和所有骨水泥，保留侧副韧带。在清创时，制作了一个活动间隔物，以便在康复期间允许部分负重和膝关节活动范围（ROM）。该间隔物使用含抗生素的骨水泥植入。为此，将4.8克硫酸妥布霉素粉末与每40克一批的Simplex骨水泥混合。骨水泥先涂抹在假体组件上，后涂抹在股骨、胫骨和髌骨上，以便在不粘连骨的情况下贴合缺损和骨面。除了这种含抗生素的骨水泥外，患者还接受了为期6周的定制静脉抗生素治疗，以治疗各种革兰氏阳性和革兰氏阴性菌。所有患者均使用含抗生素的骨水泥和标准骨水泥技术进行了骨水泥固定翻修全膝关节置换术。除1例患者外，所有患者均进行了再植入；该患者在翻修前死于无关原因。翻修前的活动范围为10度至95度。随访平均30个月（范围13 - 70个月）。翻修后改良特殊外科医院膝关节评分平均为87分（范围53 - 100分），92%的结果为良好至优秀。再植入后的活动范围为5度至106度。没有感染复发。使用活动间隔物治疗感染性全膝关节置换术可改善最终的ROM和软组织健康，并显著降低再次感染的风险。
