Surgical Technique for Implantation of Articulating Spacers with Stem Extensions for Treatment of Infection Following Total Knee Arthroplasty.
Academic Article
Overview
abstract
Introduction: This article describes our technique of adding a custom-made antibiotic-coated stem to an articulating spacer to improve fixation and effectively deliver antibiotics to the medullary canal in the treatment of infection following total knee arthroplasty. Step 1 Obtain Items Required for Intraoperative Assembly: Make sure all required items are ready prior to the start of the operation. Step 2 Remove the Components and Perform Thorough Debridement: Remove the components and debride all cement and necrotic, devitalized, and infected tissue. Step 3 Size the Spacers: Use the polyethylene insert to size the tibial spacer and the anteroposterior dimension of the explanted femoral component to size the femoral spacer. Step 4 Construct the Stems: Divide the rod, coat the rods with antibiotic cement, and connect them to the articulating components. Step 5 Implant the Spacers: Apply the cement only to the metaphysis and undersurface of the tibial spacer and place a large amount of cement on the medial and lateral condyles of the femoral spacer. Step 6 Postoperative Protocol: Patients should walk with partial weight-bearing with a brace locked in extension for three to four weeks. Results: The above technique using the articulating spacers with stem extension was employed in a two-stage revision arthroplasty to treat thirty-three patients with infection at the site of a primary or revision total knee arthroplasty3. What to Watch For: IndicationsContraindicationsPitfalls & Challenges.
