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

What to Watch For Indications

Contraindications

Pitfalls & Challenges

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.

Two-stage reimplantation continues to have the highest rate of success for eradication of periprosthetic infection after total knee arthroplasty. Articulating spacers, as compared with static spacers, have been shown to decrease bone loss, reduce …


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