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ORIGINAL ARTICLE
Year : 2014  |  Volume : 49  |  Issue : 2  |  Page : 128-133

A 'two-staged retention coverage reconstruction protocol' for early exposed septic knee prosthesis with patellar ligament disruption


Department of Orthopedic Surgery and Traumatology, Ain Shams University Hospitals, Cairo, Egypt

Correspondence Address:
Amr A.K.H Abouelela
PhD, MD, Department of Orthopedic Surgery and Traumatology, Ain Shams University Hospitals, 11588, El-Khalifa El-Maamoun St, Abbassia, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1148.145376

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Background The worst scenario in total knee arthroplasty is early wound breakdown causing prosthesis exposure and necrosis of the patellar ligament. We describe a new protocol for the salvage of early exposed septic knee prosthesis with patellar ligament disruption. Patients and methods Between October 2001 and August 2010, 15 patients (15 knees) presenting with early infected, exposed knee prosthesis with patellar ligament disruption were treated using this new protocol. Strict criteria were used for patient selection suitable for this plan of treatment. Patients had to have presented within 30 days of the index arthroplasty. In addition, no radiographic signs of osteitis or loose prosthetic component were present. In the first stage, thorough debridement accompanied by polyethylene insert removal was performed, along with intraprosthetic antibiotics-impregnated cement spacer insertion. This was followed by a 1-week parentral antibiotic regimen. On the eighth day, a second-stage procedure was performed with spacer removal and new polyethylene insertion, accompanied by medial gastrocnemius flap transposition for prosthesis coverage and patellar ligament reconstruction. Results At the latest follow-up (55.2 months), 13 knees (86.6%) have been retained; Knee Society knee and functional scores in these averaged 79.6 and 74 points, respectively, and these patients had regained sufficient extensor mechanism function to return to ambulation. Conclusion We recommend this protocol for the management of early exposed infected knee prosthesis with patellar ligament disruption. Level of evidence Level IV.


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