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Surgical Technique for the Removal of the Infected Primary TKA and 2nd Stage Revision-Part 2

January 01, 2013

Contributors: Stephen J Incavo, MD; Brian Dominues, BA; Azim Karim, MD; Azim Karim, MD

Keywords: Infection

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 It is the viewer’s responsibility to determine the educational value of this historical content.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 It is the viewer’s responsibility to determine the educational value of this historical content.

BACKGROUND: Deep infection following total knee arthroplasty (TKA) is a serious complication with a reported incidence of 1.0-4.4% after primary TKA and from 3.2-15.0% following revision TKA. Thirty-seven published studies indicate that two-stage revision arthroplasty remains the most successful management technique for deep infection following TKA with success rates averaging 92%. OBJECTIVE: We report our results from a technique using a commercially available articulating cement spacer for the treatment of deep infection in primary and revision total knee arthroplasty. METHOD: After obtaining IRB approval from our institution, we completed a two-stage reimplantation protocol on 33 patients from October 2005 to August 2009. We used an articulating spacer (InterSpace Knee®, Exactech, Gainesville, FL) that was commercially available in 3 sizes and contained 1.2 g of gentamycin in each of the femoral and tibial components. A majority of the cases required the addition of a stem to each spacer component. A 6 mm metal rod of 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 manually cemented to the preformed cement spacer. The minimum follow-up time was 24 months for inclusion. No cases of mortality occurred. RESULTS: After a minimum 24-month follow-up, the presenting infection was eradicated in 30 of 33 cases for a yielded success rate of 91%. One case after primary TKA continued to exhibit signs of infection whereas 2 out of 6 infected revision TKA cases continued to have signs of infection. CONCLUSION: We believe that augmenting spacer placement with stems facilitates antibiotic delivery into the medullary canals, are more amenable to balancing flexion and extension gaps, and provide additional stability to avoid spacer dislodgement.

Results for "Revision Knee Arthroplasty"

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