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Handmade articulating spacer for two-stage exchange at the knee

Von Hand gefertigter Gelenkspacer für den zweizeitigen Wechsel am Knie

  • Surgical Techniques
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Abstract

Objective

Two-stage exchange with implantation of a temporary spacer is considered gold standard treatment for chronic periprosthetic joint infection of the knee. This article describes a simple and safe technique for handmade articulating spacers at the knee.

Indication

Chronic or relapsing periprosthetic joint infection of the knee.

Relative contraindications

Known allergy against components of polymethylmethacrylate (PMMA) bone cements or admixed antibiotics. Inadequate compliance for two-stage exchange. Patient not able to undergo two-stage exchange. Bony defect situation at the tibia or femur leading to collateral ligament insufficiency. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy.

Surgical technique

Removal of the prosthesis, thorough debridement of necrotic and granulation tissue, tailoring bone cement with antibiotics. Preparation of a tibial and femoral stem. Customizing the tibial and femoral articulating spacer components to bony anatomy and soft tissue tension. Confirmation of correct position by intraoperative radiography.

Postoperative management

Protection of the spacer with an external brace. Restricted weight-bearing. Passive range of motion as possible. Intravenous—followed by oral antibiotics. Reimplantation after successful treatment of infection.

Zusammenfassung

Zielsetzung

Der zweizeitige Wechsel mit Implantation eines temporären Spacers gilt als Goldstandard in der Behandlung chronischer periprothetischer Gelenkinfektionen am Knie. Im Beitrag wird eine einfache und sichere Technik für manuell erstellte Gelenkspacer am Knie vorgestellt.

Indikation

Chronische oder rezidivierende periprothetische Infektion am Kniegelenk.

Relative Kontraindikationen

Bekannte Allergie gegen Bestandteile von PMMA(Polymethylmethacrylat)-Knochenzementen oder zugesetzte Antibiotika. Keine ausreichende Compliance für einen zweizeitigen Wechsel. Der Patient ist nicht in der Lage, einen zweizeitigen Austausch zu überstehen. Knöcherne Defektsituation an Tibia oder Femur, die zu einer Insuffizienz des Lig. collaterale führt. Weichteilschädigung, die einen zeitweiligen plastischen vakuumunterstützten Wundverschluss („vacuum-assisted wound closure“, VAC) erfordert.

Operationstechnik

Entfernung der Endoprothese, gründliches Débridement von nekrotischem und Granulationsgewebe, Einbringen von Knochenzement mit Antibiotika. Vorbereitung von Tibia- und Femurschaft. Anpassung der tibialen und femoralen Gelenkkomponenten des Spacers an die knöchernen Bedingungen und die Spannungsverhältnisse im Weichgewebe. Bestätigung der korrekten Platzierung durch intraoperative Röntgenaufnahmen.

Postoperative Behandlung

Schutz des Spacers durch eine externe Bandage. Teilbelastung. Schmerzadaptiert freie Beweglichkeit. Intravenöse, anschließend orale Antibiose. Reimplantation nach erfolgreicher Behandlung der Infektion.

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Authors and Affiliations

  1. Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie, Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Germany

    Martin Lüdemann, Sebastian von Hertzberg-Bölch, Anna Gurok, Jan Oberfeld & Maximilian Rudert

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  1. Martin Lüdemann
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  2. Sebastian von Hertzberg-Bölch
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  3. Anna Gurok
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  4. Jan Oberfeld
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  5. Maximilian Rudert
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Correspondence to Martin Lüdemann.

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Conflict of interest

M. Lüdemann, S. von Hertzberg-Bölch, A. Gurok, J. Oberfeld and M. Rudert declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Editor

Maximilian Rudert, Würzburg

Zeichnungen

Harald Konopatzki, Heidelberg

M. Lüdemann and S. von Hertzberg-Bölch shared first authorship.

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Lüdemann, M., von Hertzberg-Bölch, S., Gurok, A. et al. Handmade articulating spacer for two-stage exchange at the knee. Oper Orthop Traumatol 35, 154–162 (2023). https://doi.org/10.1007/s00064-023-00810-0

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  • DOI: https://doi.org/10.1007/s00064-023-00810-0

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