The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : RESEARCH PAPER

Authors
Moslem Fallah 1
Amir Shahriar Ariamanesh 2
Amir Moayedpour 1
1 Orthopedic Research Center, Ghaem Hospital, Mashhad, Iran
2 Department of Orthopedic, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/abjs.2025.87772.3972
Abstract
Objectives: Several case studies have reported the use of a two-stage primary total knee replacement as a last resort for managing infected, arthritic knee joints. However, the exact treatment protocol has not yet been clearly defined. The objective of this study was to assess the effectiveness of a two-stage primary total knee replacement, using an antibiotic-loaded cement spacer block, in treating patients with concurrent osteoarthritis and refractory joint infection.
Methods: This retrospective study evaluated the outcomes of a two-stage primary total knee arthroplasty (TKA) for the treatment of refractory septic osteoarthritic knees. A total of six cases were included. In the first stage, open debridement was performed, followed by insertion of a well-designed antibiotic-loaded static cement spacer. Systemic antibiotics were administered during the interval period between the two stages. Once the infection had been eradicated, the second-stage TKA was performed. No suppressive antibiotic therapy was prescribed after the second stage. Clinical outcomes were assessed using pre- and postoperative knee range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and visual analog scale (VAS) scores. The mean follow-up duration was two years (range, 1–4 years).
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 the two-stage TKA, the ROM significantly improved to an average of 118 degrees (range, 100–130 degrees). Additionally, the WOMAC scores improved from an initial score of 40 to 20 after TKA. The mean VAS scores also showed significant improvement, decreasing from 50 preoperatively to 19 after the TKA procedure.
Conclusion: The promising final clinical outcomes observed in this study suggest that this treatment protocol could serve as a reliable alternative for patients with infected osteoarthritic knees, providing a viable option for both restoring function and eradicating infection.
        Level of evidence: III
Keywords
Antibiotic-laden static cement spacer
Refractory Septic knee arthritis
Range of motion
Total knee arthroplasty
Two-stage arthroplasty
TKA
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 5
May 2026
Pages 343-348

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