Knee replacement surgeries are common procedures. Total knee
replacement infections can occur between 0.3% and 12.4% for primary TKR and
between 1-15% for revision TKR. When total knee infections occur, a multi-stage
reimplantation is emerging as the gold standard for the treatment of infected
total knees.
The first stage includes the removal of the infected
prosthesis and the stabilization of soft tissues. Common flaps that are used
around the knee joint include the gastrocnemius muscle flap and occasionally it
is appropriate to jump directly to free microvascular tissue transfer.
At the time that the prosthesis is removed, a temporary
antibiotic spacer is placed that elutes an antibiotic. Usually the antibiotic
is tobramycin and often vancomycin is placed in the cement.
Typically, clinical examinations are followed and laboratory
results such as CRP, ESR, and white blood cell count are monitored. Usually
after a period of 6-12 weeks when all soft tissues have stabilized and are no
longer hostile and an antibiotic course has been completed, then the antibiotic
spacer is removed and permanent knee prosthesis is placed.
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