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

• 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
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2010.12.002

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.