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Surgical Technique for Articulating Spacers with Stem Extensions To Treat The Infected TKA-Part 1

March 01, 2013

Contributors: Azim Karim, MD; Brian Domingues; Stephen J Incavo, MD; Stephen J Incavo, MD

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

Two-stage revision arthroplasty remains the most successful management technique of deep infection following TKA with success rates averaging 92% from 37 published studies. OBJECTIVES: Our purpose is to report results and the technique of using a commercially available articulating cement spacer modified by the addition of stem extensions for the treatment of deep infection in primary and revision total knee arthroplasty. Articulating cement spacers may not be an optimal solution for several reasons including the production of cement debris, loss of bony fixation, and unsuitability to cases involving bone loss. METHODS: After obtaining study approval from our institution, a total of 33 patients with infected primary or revision implants completed the two-stage re-implantation protocol from October 2005 to August 2009. The articulating spacer (InterSpace Knee®, Exactech, Gainesville, FL) was commercially available in three sizes and contained 1.2 g of gentamycin in each of the femoral and tibial components. In the majority of the cases, a stem was added to each spacer component. A 6 mm metal rod (variable length) was placed in a mold designed to uniformly coat the rod with antibiotic impregnated cement to produce a 13 mm diameter stem, which was then minimally cemented to the preformed cement spacer. For study inclusion, the minimum follow-up was 24 months. RESULTS/CONCLUSIONS: After a 24-month follow-up, the presenting infection was eradicated in 30 of 33 cases for a success rate of 91%. No cases of mortality occurred. We believe articulating cement spacers perform well in cases of deep infection. Intramedullary stems deliver antibiotics into the medullary canals, facilitate balancing flexion and extension gaps, and provide additional stability to avoid spacer dislodgement.

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