Traction-mobilisation for 2 stages treatment of infected total knee arthroplasty: about 12 cases

introduction A two stages reimplantation is advised by most authors in salv age of infected total knee arthroplasty. This treatment is more difficult, but seems more successful in controlling infection. It set the problem of t he attitude beetween the two operative stages: an antibiotic cement spacer is usually used, but articular mobilisation is not possible, except with an articulating spacer. Material and methods Since 1989, we use traction-mobilisation beetween the two operative stages, with mobilisation under traction up to 50 degrees, an d on edge of bed up to 70-90 degrees, till the reimplantation. We used this method on 12 cases of chronic infection in total knee arthroplasty. The re implantation was done 34 to 47 days later. The reimplantation was more easy and more comfortable in approach and exposition, and post operative mobili sation easier. Results We did not have any recurrence of infection in this patients, but t he follow up is too short for some of them. One prosthesis was removed for mechanical failure. The mean range of motion is 86 degrees at two months, 9 6 degrees at one year. Discussion The antibiotic cement spacer presents the desadvantage of leavin g material in a potentially infected environment. It does not allow mobilis ation, except using an articulating spacer. Traction-mobilisation keep arti cular flection, allows mobilisation, and does not leave any material in art iculation. But this method has the desadvantage of requiring an hospital ca re beetween the two stages: that is reasonable if the delay is short. Conclusion Traction mobilisation seems to be an alternative to cement space r. It makes the remplantation easier, facilitates post operative recovery o f mobility, and does not seem to increase recurrence of infection.