Treatment of Stage III-A-1 and III-B-1 Periprosthetic Knee Infection With Two-Stage Exchange Arthroplasty and Articulating Spacer


The incidence of periprosthetic knee infection is generally low, but the economic impact is great. Treatment should take into account the acuteness of the infection, the overall immune/medical status of the patient, and the local factors at the site of the infection. The aim of this study was to evaluate the two-phase exchange arthroplasty with the use of antibiotic-impregnated articulating spacer, as an alternative treatment of chronic periprosthetic knee infection in patients with minimum systemic and no local compromising factors. Staphylococcus aureus was the most common pathogen followed by Staphylococcus epidermidis and Pseudomonas aeruginosa. Twenty-four patients were treated with this regiment. All of them returned to normal everyday activity and no infection recurrence was noted over a 2- to 10-year follow-up. Excellent long-term results can be achieved for patients staged as III-A-1 and III-B-1 according to the Musculoskeletal Infection Society staging system, when treated with the aforementioned protocol and intravenous antibiotics. (Journal of Surgical Orthopaedic Advances 17(3):173–178, 2008)

George C. Babis, MD, Konstantinos A. Zahos, MD, Panagiotis Tsailas, MD,
Georgios I. Karaliotas, MD, Kyriaki Kanellakopoulou, MD, and Panayotis N.
Soucacos, MD, FACS