Patellar Resurfacing in Total Knee Arthroplasty: A Contentious Matter.

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Abstract

Conflict of interest statement: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. 8. Clin Orthop Relat Res. 2007 Nov;464:164-78. doi: 10.1097/BLO.0b013e318157eb1e. Technique and timing of two-stage exchange for infection in TKA. Burnett RS(1), Kelly MA, Hanssen AD, Barrack RL. Author information: (1)Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO 63110, USA. Infection in total knee arthroplasty is a devastating complication. The two-stage exchange procedure has evolved as an effective treatment option. The classification and alternatives to a two-stage procedure are presented. Current diagnosis and monitoring of infection in total knee arthroplasty with laboratory, aspiration, and imaging techniques are reviewed. The timing, technique, and results of a two-stage procedure are discussed. A knee aspiration with synovial fluid cell count and culture may be a useful adjunct. The use of antibiotic-impregnated cement spacers may be considered at the first-stage surgery. Spacers may be static or articulating, intramedullary dowels, preformed or constructed in the operating room, and provide single- or multiple-agent antibiotic (and antifungal) joint space delivery. Proper technique, antibiotic dosing, and indications with these devices will avoid complications between stages. The most common complications encountered with the use of spacers include dislocation/instability, implant extrusion, overstuffing of the patellofemoral and tibiofemoral joints, and implant or periprosthetic fracture. At the second stage of the procedure, surgical exposure, intraoperative frozen sections, assessment of bone and soft tissue defects, the integrity of the extensor mechanism, and implant selection are important factors to consider in the second-stage reimplantation revision total knee arthroplasty. LEVEL OF EVIDENCE: Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. DOI: 10.1097/BLO.0b013e318157eb1e