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First Stage Revision of Infected TKR: A Technique of Handcrafted Articulating Spacers and Cement Pancake Soft Tissue Spacers

  • Surgical Technique
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Abstract

This is a study to see if improvised ‘articulating antibiotic cement spacers’ work in two-stage revisions for infected TKRs with bone defects in the condyles. The second objective is to see if adhesions can be prevented between intra-articular bone and soft tissue around it after the first stage to make exposure of the joint easy and quick in the second stage. Six cases were selected which had moderate defects of femoral or tibial condyles and a modified technique was used to prepare articulating cement spacers. Antibiotic cement moulded like pancakes was placed on the exposed raw areas of the femur and tibia. Patients were mobilised with protected weight-bearing after the surgery and active knee flexion was encouraged. Patients regained a mean of 80 degrees of knee flexion during the interval between the stages and a mean of 100 degrees of flexion following the second stage. There was no bone loss while removing the modified cement spacers. Patients had no significant intra-articular adhesions and hence the exposure of the knee joint during the second stage did not require further intra-articular dissection. Standard articulating spacers are not suitable in the cases with bone loss of the condyles. Our modified technique allowed us to use it in cases with moderate bone loss also where static spacers are used otherwise. This helped to mobilise these knees between the two stages of revision instead of keeping immobilised with static spacers. Antibiotic cement pancakes prevented intra-articular adhesions and carried an extra dose of antibiotic into the joint.

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References

  1. Wilde, A. H., & Ruth, J. T. (1988). Two-stage reimplantation in infected total knee arthroplasty. Clinical Orthopaedics and Related Research, 236, 23–35.

    Article  Google Scholar 

  2. Hofmann, A. A., Kane, K. R., Tkach, T. K., Plaster, R. L., & Camargo, M. P. (1995). Treatment of infected total knee arthroplasty using an articulating spacer. Clinical Orthopaedics and Related Research, 321, 45–54.

    Google Scholar 

  3. Nickinson, R. S. J., Board, T. N., Gambhir, A. K., Porter, M. L., & Kay, P. R. (2012). Two stage revision knee arthroplasty for infection with massive bone loss. A technique to achieve spacer stability. The Knee., 19, 24–27.

    Article  CAS  PubMed  Google Scholar 

  4. Freeman, M. G., Fehring, T. K., Odum, S. M., Fehring, K., Griffin, W. L., & Mason, J. B. (2007). Functional advantage of articulating versus static spacers in 2-stage revision for total knee arthroplasty infection. Journal of Arthroplasty, 22, 1116–1121.

    Article  PubMed  Google Scholar 

  5. Voleti, P. B., Baldwin, K. D., & Lee, G. C. (2013). Use of static or articulating spacers for infection following total knee arthroplasty: a systematic literature review. Journal of Bone and Joint Surgery. American Volume, 95, 1594–1599.

    Article  PubMed  Google Scholar 

  6. Durbhakula, S. M., Czajka, J., Fuchs, M. D., & Uhl, R. L. (2004). Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected total knee arthroplasty. Journal of Arthroplasty, 19, 768–774.

    Article  PubMed  Google Scholar 

  7. Kohl, S., Evangelopoulos, D. S., Kohlhof, H., Krueger, A., Hartel, M., & Roeder, C. (2011). An intraoperatively moulded PMMA prostheses like spacer for two-stage revision of infected total knee arthroplasty. The Knee., 18(6), 464–469.

    Article  PubMed  Google Scholar 

  8. Haddad, F. S., Masri, B. A., Campbell, D., McGraw, R. W., Beauchamp, C. P., & Duncan, C. P. (2000). The PROSTALAC functional spacer in two-stage revision for infected prosthesis of antibiotic-loaded acrylic cement. Journal of Bone and Joint Surgery. British Volume, 82, 807–812.

    Article  CAS  PubMed  Google Scholar 

  9. Villanueva, M., Rios, A., Pereiro, J., Fahandez-Saddi, H., & Villamor. (2008). Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients. Acta Orthopaedica, 79, 674–682.

    Article  Google Scholar 

  10. Burnett, R. S., Kelly, M. A., Hanssen, A. D., & Barrack, R. L. (2007). Technique and timing of two-stage exchange for infection in TKA. Clinical Orthopaedics and Related Research, 464, 164–178.

    Article  PubMed  Google Scholar 

  11. Fehring, T. K., Odum, S., Calton, T. F., et al. (2000). Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award. Clinical Orthopaedics and Related Research, 380, 9–16.

    Article  Google Scholar 

  12. Calton, T. F., Fehring, T. K., & Griffin, W. L. (1997). Bone loss associated with the use of spacer blocks in infected total knee arthroplasty. Clinical Orthopaedics and Related Research, 345, 148–154.

    Article  Google Scholar 

  13. Emerson, R. H., Jr., Muncie, M., Tarbox, T. R., & Higgins, L. L. (2002). Comparison of a static with a mobile spacer in total knee infection. Clinical Orthopaedics and Related Research, 404, 132–138.

    Article  Google Scholar 

  14. Goldman, R. T., Scuderi, G. R., & Insall, J. N. (1996). 2-stage reimplantation for infected total knee replacement. Clinical Orthopaedics and Related Research, 331, 118–124.

    Article  Google Scholar 

  15. Goksan, S. B., & Freeman, M. A. (1992). One-stage reimplantation for infected total knee arthroplasty. Journal of Bone and Joint Surgery. British Volume, 74, 78–82.

    Article  CAS  PubMed  Google Scholar 

  16. Mazzucchelli, L., Rosso, F., Marmotti, A., EdoardoBonasia, D., Bruzzone, M., & Rossi, R. (2015). The use of spacers (static and mobile) in infection knee arthroplasty. Current Reviews in Musculoskeletal Medicine, 8(4), 373–382.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

MVR for his assistance and guidance in preparing the manuscript

Funding

None of the authors received any funding for this study or preparation for publication.

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Authors and Affiliations

  1. Apollo Hospital, #957, International Pavilion, Jubilee Hills, Hyderabad, 500033, Telangana, India

    Somasekhara Reddy Nallamilli

  2. Glan Clwyd Hospital, Rhyl, Bodelwyddan, LL18 5UJ, UK

    Rajyalakshmi N. Reddy

  3. Apollo Hospital, Hyderabad, India

    Mohan Krishna Althuri

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  1. Somasekhara Reddy Nallamilli
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  2. Rajyalakshmi N. Reddy
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  3. Mohan Krishna Althuri
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Correspondence to Somasekhara Reddy Nallamilli.

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Above three authors have no conflict of interest in this study.

Ethical approval and Informed consent

The study material included in this article has gone through the institutional ethics committee and was approved. Six cases were included in this study. Appropriate pre-operative preparations were carried out. The joint fluid was aspirated for culture after stopping antibiotics for one week and a separate culture sample was taken from a discharging sinus in one patient. They were all counselled for two-stage revision surgery and informed consent was taken.

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Nallamilli, S.R., Reddy, R.N. & Althuri, M.K. First Stage Revision of Infected TKR: A Technique of Handcrafted Articulating Spacers and Cement Pancake Soft Tissue Spacers. JOIO 56, 2086–2092 (2022). https://doi.org/10.1007/s43465-022-00739-9

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  • DOI: https://doi.org/10.1007/s43465-022-00739-9

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