Two-stage primary Total Knee Arthroplasty (TKA) for Treatment of Refractory Septic Knee Osteoarthritis: A Retrospective Study

Articles in Press

Document Type : RESEARCH PAPER

Authors

Department of Orthopedic, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

10.22038/abjs.2025.87772.3972

Abstract

Abstract

Objectives:There are a few case studies that describe using a two-stage primary knee replacement as a last resort for treating an infected, arthritic knee joint. However, the specific treatment process has not been clearly defined yet. The goal of this study was to evaluate how effective it is to use a two-stage primary total knee replacement with an antibiotic-laden cement spacer block to treat knees that have both osteoarthritis and refractory infection.

Method :This retrospective study evaluated the outcomes of a two-stage primary TKA (TKA) procedure for the treatment of refractory septic osteoarthritic knees. The study included 6 cases. In the first stage, open debridement was performed, followed by the insertion of a well-designed antibiotic-laden static cement spacer. Systemic antibiotics were administered during the interval period between the two stages. After the infection was eradicated, the second-stage TKA was performed. No suppressive antibiotic therapy was prescribed after the second stage. The researchers assessed the patients' pre- and post-operative knee range of motion (ROM), WOMAC scores, and VAS scores .mean follow-up duration was two years (range, 1-4years)

Results:

Complete eradication of infection was successfully achieved within an average follow-up period of two years. Before the initial stage surgery, the average range of motion (ROM) was 60 degrees(range, 40-120 degrees), following TKA (TKA), the ROM significantly improved to an average of 118 degrees (range, 100-130 degrees). Additionally, the WOMAC scores showed improvement from an initial score of 40 to 20 after TKA. The mean VAS scores also demonstrated improvement, decreasing from 50 preoperative to 19 after the TKA procedure.

Conclusion :The encouraging final clinical outcomes observed in this study suggest that this treatment protocol could serve as a reliable alternative for patients with infected osteoarthritic knees, offering a viable option for restoring function and eradicating infection.

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Main Subjects

The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 24 February 2026

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History

  • Receive Date: 26 April 2025
  • Revise Date: 23 February 2026
  • Accept Date: 12 July 2025

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