A. Siegel et al., Radical synovectomy and implantation of a cemented stabilized knee prosthesis to treat bacterial gonitis, CHIRURG, 71(11), 2000, pp. 1385-1391
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.