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Latest Surgical Technique

June 12, 2013

Surgical Technique for Implantation of Articulating Spacers with Stem Extensions for Treatment of Infection Following Total Knee Arthroplasty

by Morteza Meftah, MD; Azim A. Karim, MD; Stephen J. Incavo, MD

Overview

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.

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More Surgical Techniques

May 22, 2013

Arthroscopic Treatment of Osteochondral Talar Defects

by Christiaan J.A. van Bergen, MD; Ruben Zwiers, MSc; C. Niek van Dijk, MD, PhD

May 08, 2013

All-Inside, All-Epiphyseal Autograft Reconstruction of the Anterior Cruciate Ligament in the Skeletally Immature Athlete

by Peter D. Fabricant, MD, MPH; Moira M. McCarthy, MD; Frank A. Cordasco, MD, MS; Daniel W. Green, MD, MS

April 24, 2013

Reconstruction of Proximal Humeral Defects with Shoulder Arthrodesis Using Free Vascularized Fibular Graft: Surgical Technique

by Mehmet Armangil, MD; S. Sinan Bilgin, MD

April 10, 2013

Unconstrained Shoulder Arthroplasty for Treatment of Proximal Humeral Nonunions: Surgical Technique

by Thomas R. Duquin, MD; John W. Sperling, MD; Robert H. Cofield, MD

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Recently Published in The Journal of Bone & Joint Surgery:

Early Prospective Clinical Results of a Modern Fixed-Bearing Total Ankle Arthroplasty

Risk Factors for Readmission of Orthopaedic Surgical Patients

Recently Published in JBJS Case Connector:

Sinus Tract Formation After Arthroplasty of the Shoulder Secondary to Tuberculosis: A Case Report and Review of the Literature

An Unexpected Foreign Body in the Knee: A Case Report

Go to Journal of Bone & Joint Surgery

Go to Case Connector

Go to jbjsjobs.org

02/04/2013 Academic Orthopaedic Surgeons MI - Wayne State University School of Medicine	05/15/2013 Chief of Sports Medicine Orlando, Florida FL - Orlando Health Orthopedic Institute
06/05/2013 Fellowship Trained Orthopedic Surgeons WV - Charleston Area Medical Center	04/17/2013 Fellowship Trained Spine Surgeon NY - New York Spine Specialists

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Current Discussion

John H. Wedge, MD, FRCS(C) responds to:

Outcome at Forty-five Years After Open Reduction and Innominate Osteotomy for Late-Presenting Developmental Dislocation of the HipSurgical Technique

I would like to thank Mr. Cove for pointing out an obvious typographical error in our manuscript. The vessel described is indeed a branch of the lateral, rather than the medial circumflex femoral a

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