Case Of the Week (COW) 14 Sep 2014
Answer:
Septic arthritis with antibiotic impregnated cement beads in situ.
Findings:
Removal of knee joint replacement prosthesis with post operative changes.
Joint space reduction, marginal osteophytes and sclerosis of joint articulating ends. No osteopenia seen. No loose bodies seen.
Antibiotic impregnated cement beads as spacer seen in joint space.
Discussion:
Management of an infected total knee implant is a major challenge. The use of antibiotic-cement beads block in two-stage reimplanation of septic total knee arthroplasties, serves as an antibiotic delivery system between the time of component removal and reimplantation, the antibiotic-impregnated spacer block imparts mechanical stability to the joint and decreases the morbidity during the period before reimplantation. This temporary "interposition arthroplasty" facilitates the patient's ambulation and also simplifies dissection at the time of reimplantation. Osteoporotic bone at the time of resection becomes firm, good-quality bone by the time of reimplantation.
References:
1.Cohen JC, Hozack WJ, Cuckler JM, Booth RE., Jr Two-stage reimplantation of septic total knee arthroplasty: report of three cases using an antibiotic-PMMAspacer block. J Arthroplasty. 1988;3(4):369–377.
2.Hsu CS, Hsu CC, Wang JW, Lin PC. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J. 2008;31(6):583–591.
3.Antonio Silvestre, Fernando Almeida, Pablo Renovell, Elena Morante, Raúl López, Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer Clin Orthop Surg. Sep 2013; 5(3): 180–187. Published online Aug 20, 2013. doi: 10.4055/cios.2013.5.3.180 PMCID: PMC3758987
Contributed by:
Dr. Premkumar Chidambaram MD
Consultant Radiologist, Parvathy Hospital, Chennai
Assistant Professor, SRM Medical College
Answer:
Septic arthritis with antibiotic impregnated cement beads in situ.
Findings:
Removal of knee joint replacement prosthesis with post operative changes.
Joint space reduction, marginal osteophytes and sclerosis of joint articulating ends. No osteopenia seen. No loose bodies seen.
Antibiotic impregnated cement beads as spacer seen in joint space.
Discussion:
Management of an infected total knee implant is a major challenge. The use of antibiotic-cement beads block in two-stage reimplanation of septic total knee arthroplasties, serves as an antibiotic delivery system between the time of component removal and reimplantation, the antibiotic-impregnated spacer block imparts mechanical stability to the joint and decreases the morbidity during the period before reimplantation. This temporary "interposition arthroplasty" facilitates the patient's ambulation and also simplifies dissection at the time of reimplantation. Osteoporotic bone at the time of resection becomes firm, good-quality bone by the time of reimplantation.
References:
1.Cohen JC, Hozack WJ, Cuckler JM, Booth RE., Jr Two-stage reimplantation of septic total knee arthroplasty: report of three cases using an antibiotic-PMMAspacer block. J Arthroplasty. 1988;3(4):369–377.
2.Hsu CS, Hsu CC, Wang JW, Lin PC. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J. 2008;31(6):583–591.
3.Antonio Silvestre, Fernando Almeida, Pablo Renovell, Elena Morante, Raúl López, Revision of Infected Total Knee Arthroplasty: Two-Stage Reimplantation Using an Antibiotic-Impregnated Static Spacer Clin Orthop Surg. Sep 2013; 5(3): 180–187. Published online Aug 20, 2013. doi: 10.4055/cios.2013.5.3.180 PMCID: PMC3758987
Contributed by:
Dr. Premkumar Chidambaram MD
Consultant Radiologist, Parvathy Hospital, Chennai
Assistant Professor, SRM Medical College