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Spacer aspiration, C-reactive protein unable to determine timing for TKA
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PRAGUE — Neither spacer aspiration nor C-reactive protein-values provided a reliable method for determining the correct timing for total knee arthroplasty reimplantation, according to results presented at the 16th EFORT Congress.
“PMMA [polymethyl methacrylate]-spacer aspiration and the CRP [C-reactive protein] values are insufficient to determine the persistence of infection during two-stage revision arthroplasty,” Bernd Preininger, of the Center for Musculoskeletal Surgery in Berlin, Germany, said in his presentation. “Other parameters need to be found and evaluated in order to make decisions and do the timing before reimplantation.”
Bernd Preininger
Preininger and colleagues analyzed 62 patients undergoing two-stage septic knee revision surgery. The researchers performed a temporary knee arthrodesis through internal fixation combined with a PMMA-spacer after an initial explantation and septic debridement. A synovial aspiration was performed 6 weeks following spacer implantation and after an antibiotic-free interval. At the time of explantation of the prosthesis, synovial aspiration and total knee arthroplasty (TKA) reimplantation, the researchers collected CRP-values.
According to Preininger, PMMA-spacer aspiration had low sensitivity, and CRP-values had moderate sensitivity but poor specificity.
“In 34 cases, the criteria of persistence of infection was still met in the secondary surgery, but only in seven cases could this be detected through the synovial aspiration,” Preininger said.
He also noted results showed synovial aspiration was a false-negative in 27 cases. – by Casey Tingle
Reference:
Preininger B, et al. Paper #2116. Presented at: 16th EFORT Congress; May 27-29, 2015; Prague.
Disclosure: Preininger reports no relevant financial disclosures.