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

Developing a strategy to treat established infection in total knee replacement

“…a balanced, functional joint. Static spacers maybe so unbalanced as to produce frank instability, 44,45 causing further damage to soft tissues and bone; the extensor mechanism is particularly at risk. Mobile spacers allow some attempt to balance the soft tissues, but with limited options, and again instability is a problem.…”

Minimizing Dynamic Knee Spacer Complications in Infected Revision Arthroplasty

“…Spacers were originally custom-made and nonarticulating, static cement blocks of various shapes [11,14,35,42], which had the advantages of being cost-effective and simple to use. However, reports have documented shortcomings of nonarticulating spacers, including the potential for increased bone loss [24,41,49], decreased ROM, and flexion contractures at final revision surgery [14,42], which may lead to a difficult surgical exposure and reduced patient functionality postoperatively.…”

“…Purported advantages of these articulating spacers include allowing the patient to ambulate more easily and maintain some ROM and functionality while possibly not creating as difficult of an exposure during the ultimate revision procedure [11,14,15,19,42]. These advantages do not come without some cost because these articulating spacers have the potential for decreased implant stability and durability [27,46] and inability to effectively handle extreme bone loss [24,41].…”

Unsatisfactory Outcome of Arthrodesis Performed After Septic Failure of Revision Total Knee Arthroplasty

“…Most authors prefer a two-stage revision arthroplasty with the placement of a static or mobile cement spacer [8][9][10][11][12][13] . Despite surgical debridement and systemic antibiotic therapy, the recent literature has shown reinfection rates of 15% to 24% following revision surgery for periprosthetic infection, which is possibly due to the shift in the pathogen spectrum to multiresistant bacteria such as methicillin-resistant Staphylococcus aureus or epidermidis or vancomycin-resistant enterococci [11][12][13][14][15][16][17] . If the infection is not eradicated after a one-stage or twostage revision total knee arthroplasty, permanent suppression therapy with antibiotics, amputation, or arthrodesis are treatment Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work.…”