title: Two stage revision knee arthroplasty for infection with massive bone loss. A technique to achieve spacer stability.
abstract: We report a technique for the intra-operative production of an antibiotic-impregnated cement spacer, reinforced with an intramedullary nail. The spacer is designed for use in cases where significant bone loss and/or ligamentous instability prevent the formation of a stable joint when using a conventional spacer during a two-stage revision knee arthroplasty. This technique has been performed in eleven patients. Nine patients have subsequently undergone a second-stage procedure. Two patients died of unrelated causes before a second-stage could be performed. In all but one case, the infection has been successfully eradicated and patients remain infection free at a mean follow-up of 32 months (range 21-64 months). We believe that the described technique is an effective alternative to the traditional spacer, in patients with significant bone loss and/or ligamentous instability. It delivers antibiotics locally, while producing a mechanically stable joint, on which the patient can mobilise, maintaining leg length and tissue tensions.
authors.affiliation: Manchester Royal Infirmary, Oxford Road, Manchester, UK. rnickinson@doctors.org.uk
authors.forename: R S J
authors.initials: RS
authors.lastname: Nickinson
authors.forename: T N
authors.initials: TN
authors.lastname: Board
authors.forename: A K
authors.initials: AK
authors.lastname: Gambhir
authors.forename: M L
authors.initials: ML
authors.lastname: Porter
authors.forename: P R
authors.initials: PR
authors.lastname: Kay
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001843:Bone Cements; D001858:Bone Nails; D004343:Drug Implants; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004343:Drug Implants