Infection cure rate and functional results after 40 two-stage and 28 one-stage cemented reimplatations for knee prosthesis infected by methicillin resistant staphylococcus aureus

Introduction. The study compares infection cure rate and functional results after oneand two-stage revision of total knee prosthesis due to MRSA infection. Material and methods. Results of 28 one-stage cemented revisions with addition of 5% of vancomycin and 40 two-stage revisions with hand-made, articulating cement spacer containing 5% of vancomycin were compared. The average follow up was 4.5 years ( 3 to 7.5 years ). Functional results were assessed in HSS, HKASS and WOMAC scores. As good result the lack of clinical, radiological and biochemical signs of infection, more than 61 points in HSS score and more than 50 points in HKASS score were assumed. Results were statistically analysed. Results. The infection cure rate was 95% after two-stage reimplantation with articulating spacer and 89,3% after one-stage revision. Functional results in HSS score were significantly better after two-stage reimplantations than after one-stage reimplantations (average 78.9 points vs 65.8 points, p-value 0.05; CI 95%: 72.4-95.6%). The satisfaction with treatment on HKASS scale was higher after two-stage than after one-stage revision ( average 78.5 points vs 68.3 points), but not statistically significant. Conclusions. The study demonstrated better cure rate and functional results after two-stage reimplantation with hand-made, articulating cement spacer containing 5% of vancomycin – as compared to one-stage reimplantation using the same acrylic cement for prosthesis fixation performed due to infection of knee prosthesis with MRSA.