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Do Antibiotic-Impregnated Intramedullary Dowels Assist in Eradicating Infection in Total Knee Arthroplasty?

  • Michael M. Kheir
    Affiliations
    Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
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  • R. Michael Meneghini
    Correspondence
    Reprint requests: R. Michael Meneghini, MD, Department of Orthopaedic Surgery, Indiana University Health Physicians, Orthopedics and Sports Medicine, Indiana University School of Medicine, 13100 East 136th Street, Suite 2000, Fishers, IN 46037.
    Affiliations
    Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN

    Department of Orthopaedic Surgery, Indiana University Health Physicians, Indiana University School of Medicine, Fishers, IN
    Search for articles by this author

      Abstract

      Antibiotic-impregnated intramedullary dowels historically have been advocated and are frequently used to facilitate periprosthetic knee infection eradication. They are used for focused delivery of antibiotics into the femoral and tibial intramedullary canals during 2-stage resection utilizing an antibiotic cement spacer. However, the literature is limited on the use and efficacy of antibiotic-eluding intramedullary dowels in periprosthetic joint infection. We reviewed the available literature and have found that the data at this point are equivocal with respect to whether antibiotic-impregnated cement intramedullary dowels augment the intra-articular antibiotic cement spacer in eradicating infection in total knee arthroplasty. Thus, we believe that the decision to use dowels can be left up to the surgeon preference. However, further research is warranted to review operative room efficiency and healthcare costs, and to validate the clinical efficacy of antibiotic-impregnated dowels in periprosthetic joint infection.

      Keywords

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      References

        • Parvizi J.
        • Gehrke T.
        • Mont M.A.
        • Callaghan J.J.
        Introduction: proceedings of international consensus on orthopedic infections.
        J Arthroplasty. 2019; 34: S1-S2https://doi.org/10.1016/j.arth.2018.09.038
        • Hanssen A.D.
        • Spangehl M.J.
        Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements.
        Clin Orthop Relat Res. 2004; : 79-85https://doi.org/10.1097/01.blo.0000143806.72379.7d
        • McPherson E.J.
        • Patzakis M.J.
        • Gross J.E.
        • Holtom P.D.
        • Song M.
        • Dorr L.D.
        Infected total knee arthroplasty. Two-stage reimplantation with a gastrocnemius rotational flap.
        Clin Orthop Relat Res. 1997; : 73-81
        • Zielinski M.R.
        • Ziemba-Davis M.
        • Warth L.C.
        • Keyes B.J.
        • Meneghini R.M.
        Do antibiotic intramedullary dowels assist in eradicating infection in two-stage resection for septic total knee arthroplasty?.
        J Arthroplasty. 2019; 34: 2461-2465https://doi.org/10.1016/j.arth.2019.05.022