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.
What to Watch For
Pitfalls & Challenges