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Surgical Technique for Implantation of Articulating Spacers with Stem Extensions for Treatment of Infection Following Total Knee Arthroplasty
Morteza Meftah, MD1; Azim A. Karim, MD1; Stephen J. Incavo, MD1
1 Methodist Center For Orthopedic Surgery, 6550 Fannin Street, Suite 2600, Houston, TX 77030. E-mail address for M. Meftah: MeftahM@hss.edu
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Based on an original article: J Arthroplasty. 2012 Sep;27(8):1469-73.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Jun 12;3(2):e11 1-6. doi: 10.2106/JBJS.ST.M.00011
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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.


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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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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