Morteza Meftah1, Azim A Karim1, Stephen J Incavo1. 1. Methodist Center For Orthopedic Surgery, 6550 Fannin Street, Suite 2600, Houston, TX 77030. E-mail address for M. Meftah: MeftahM@hss.edu.
Abstract
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: IndicationsContraindicationsPitfalls & 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. 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: IndicationsContraindicationsPitfalls & Challenges.