‘2 in 1’ single stage revision of infected Total Knee Arthroplasty using metaphyseal femoral and tibial sleeves: early experience

Introduction: Two-stage revision is a widely accepted and performed intervention for septic total knee arthroplasty (TKA), with an infection eradication rate exceeding 90% in most studies. The ‘2-in-1’ single stage revision has recently been reported to have favourable results. Aim: To evaluate the early clinical results of single-stage reimplantation of infected TKA using stepped metaphyseal femoral and tibial sleeves. Methods: From March 2009 to January 2010, 8 patients with a diagnosis of infected total knee arthroplasty were treated with ‘2 in 1’ single-stage reimplantation in our institution. There were 4 men and 4 women with an average age of 71 years. The revision operation was performed in patients presenting with an infected TKA and who had mild to moderate tibial or femoral bone loss. We used extraction of implants, debridement and lavage in the first stage and re-draped patients prior to the second stage which included the definitive implantation. All the patients received intravenous antibiotics for two weeks and oral antibiotics were continued for further 6–12 weeks until the serum CRP & WBC were normal. None of these patients required intra operative bone allografting. Results: Clinical evaluation at the last follow up showed significant improvement in the knee pain and stiffness score. Radiological evaluation was done using the Knee Society system. None of the knees showed evidence of infection or loosening at the mean follow up of eighteen months. Conclusion: Metaphyseal femoral and tibial sleeves may enable reconstruction of contained and uncontained bone stock, insertion of a stable implant and control of infection in a single operation in revision TKR for infection. The increased morbidity and cost of a two-stage procedure is thus avoided