Hee-Nee Pang1, Renyi Benjamin Seah2, Steven J MacDonald3. 1. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. 2. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. Electronic address: ben_seah@hotmail.com. 3. Division of Orthopaedic Surgery, Joint Replacement Institute, London Health Sciences Centre, ON, Canada.
Abstract
BACKGROUND: We present a case of multifocal infection involving the left total hip replacement and the right total knee replacement of a patient, further complicated by an infected non-union of a periprosthetic fracture of the right knee. This required the unique simultaneous management of both infection eradication and fracture stabilization in the knee. METHODS: Both sites were treated with a two-stages procedure, including the novel use of a stemmed articulating spacer for the right knee. This spacer was made combining a retrograde humeral nail, coated with antibiotic-impregnated cement, and a pre-formed articulating cement spacer. The patient was able to weight-bear on this spacer. RESULTS: The fracture went on to unite, and a second stage was performed with the use of stemmed prosthesis and augments. She remains infection free two years after the second stage operation. CONCLUSIONS: The use of a stemmed articulating knee spacer can facilitate infection eradication and fracture stabilization while preserving some motion and weight-bearing ability in the two-stages management of an infected periprosthetic fracture of the knee. LEVEL OF EVIDENCE: Level V (Case report).
BACKGROUND: We present a case of multifocal infection involving the left total hip replacement and the right total knee replacement of a patient, further complicated by an infected non-union of a periprosthetic fracture of the right knee. This required the unique simultaneous management of both infection eradication and fracture stabilization in the knee. METHODS: Both sites were treated with a two-stages procedure, including the novel use of a stemmed articulating spacer for the right knee. This spacer was made combining a retrograde humeral nail, coated with antibiotic-impregnated cement, and a pre-formed articulating cement spacer. The patient was able to weight-bear on this spacer. RESULTS: The fracture went on to unite, and a second stage was performed with the use of stemmed prosthesis and augments. She remains infection free two years after the second stage operation. CONCLUSIONS: The use of a stemmed articulating knee spacer can facilitate infection eradication and fracture stabilization while preserving some motion and weight-bearing ability in the two-stages management of an infected periprosthetic fracture of the knee. LEVEL OF EVIDENCE: Level V (Case report).