title: Two-stage exchange arthroplasty using a functional antibiotic-loaded spacer in the treatment of the infected knee replacement: the Vancouver experience.
abstract: Two-stage exchange arthroplasty is currently the method of choice in the treatment of the infected knee replacement. The prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is a temporary, antibiotic-loaded functional prosthesis that is used as an interim spacer in two-stage exchange arthroplasty. In this prospective series, we report on the early results of the use of the PROSTALAC knee spacer in two-stage exchange arthroplasty of infected knees. A total of 24 knees were treated with this prosthesis, and were reviewed at a mean follow-up time of 2.2 years. Infection was controlled in all but 2 knees, for an infection cure rate of 91.7%. The patients' function was improved between stages, and motion was maintained in the majority of cases. The significant complications with the PROSTALAC implant in place were tibio-femoral instability, which was corrected with a design modification, and patellar instability, which continues to be a problem. These complications were transient and were not of any significance after the second stage.
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
authors.forename: B A
authors.initials: BA
authors.lastname: Masri
authors.forename: R W
authors.initials: RW
authors.lastname: Kendall
authors.forename: C P
authors.initials: CP
authors.lastname: Duncan
authors.forename: C P
authors.initials: CP
authors.lastname: Beauchamp
authors.forename: R W
authors.initials: RW
authors.lastname: McGraw
authors.forename: B
authors.initials: B
authors.lastname: Bora
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001843:Bone Cements; D002170:Canada; D016503:Drug Delivery Systems; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects* / Q000379:methods*; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D012086:Reoperation; D016896:Treatment Outcome