Two stage revision knee arthroplasty for infection with massive bone loss. A technique to achieve spacer stability

Two stage revision knee arthroplasty for infection with massive bone loss. A technique to achieve spacer stability

Abstract We report a technique for the intra-operative production of an antibiotic-impregnated cement spacer, reinforced with an intramedullary nail. The spacer is designed for use in cases where significant bone loss and/or ligamentous instability prevent the formation of a stable joint when using...

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Bibliographic Details
Published in:The knee Vol. 19; no. 1; pp. 24 - 27
Main Authors: Nickinson, R.S.J, Board, T.N, Gambhir, A.K, Porter, M.L, Kay, P.R
Format: Journal Article
Language:English
Published: Netherlands Elsevier B.V 01-01-2012
Elsevier Limited
Subjects:
Aged
Anti-Bacterial Agents - administration & dosage
Arthroplasty, Replacement, Knee - adverse effects
Bone Cements
Bone Nails
Cement spacer
Drug Implants
Female
Humans
Infection
Intramedullary nail
Knee arthroplasty
Knee Joint - pathology
Knee Joint - physiopathology
Knee Joint - surgery
Knee Prosthesis
Male
Middle Aged
Orthopedics
Prosthesis Design
Prosthesis-Related Infections - drug therapy
Prosthesis-Related Infections - surgery
Recovery of Function
Reoperation
Revision
Treatment Outcome
Infection
Intramedullary nail
Cement spacer
Revision
Knee arthroplasty
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Summary:Abstract We report a technique for the intra-operative production of an antibiotic-impregnated cement spacer, reinforced with an intramedullary nail. The spacer is designed for use in cases where significant bone loss and/or ligamentous instability prevent the formation of a stable joint when using a conventional spacer during a two-stage revision knee arthroplasty. This technique has been performed in eleven patients. Nine patients have subsequently undergone a second-stage procedure. Two patients died of unrelated causes before a second-stage could be performed. In all but one case, the infection has been successfully eradicated and patients remain infection free at a mean follow-up of 32 months (range 21–64 months). We believe that the described technique is an effective alternative to the traditional spacer, in patients with significant bone loss and/or ligamentous instability. It delivers antibiotics locally, while producing a mechanically stable joint, on which the patient can mobilise, maintaining leg length and tissue tensions.
Bibliography:ObjectType-Article-1
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ISSN:0968-0160
1873-5800
DOI:10.1016/j.knee.2010.12.002