Radical synovectomy and implantation of a cemented stabilized knee prosthesis to treat bacterial gonitis

Introduction: The report presents an alternative to the treatment of joint destruction in cases of knee joint empyema by resection or arthrodesis: imp lantation of a stabilised knee prosthesis using antibiotic-loaded bone ceme nt for fixation. Method: From 1985 to 1997 a total of 33 knees in 32 patien ts (21 female, 12 male) were treated for knee empyema by radical synovectom y and implantation of a stabilised knee prosthesis fixed in position with a ntibiotic-loaded bone cement. The antibiotics were chosen according to the antibiogram of the pathogen. In all these cases the infections had not resp onded to previous treatment. The criterion for success was the elimination of infection. The follow-up period ranged from 2 to 15 years. Results: Of 3 3 infected knees 31 (93.9 %) were followed up. In 22 cases (71.0 %) the inf ection was eliminated by primary surgery. In five cases (16.1 %) further ex change operations were necessary to eliminate the infection. In four cases (12.9 %) preservation of the joint was not possible. Conclusion: Uncontroll ed infection in cases of knee empyema and destruction of the joint can be t reated by radical synovectomy and implantation of a stabilised knee prosthe sis using antibiotic-loaded bone cement for fixation. The success rate corr esponds to the results of one-stage exchange arthroplasty to treat peripros thetic infection of knee prostheses. This therapy should be performed only in specialised centres which have the facilities and personnel essential fo r accurate bacteriological diagnosis and recommendation.