title: Intramedullary rod and cement static spacer construct in chronically infected total knee arthroplasty.
abstract: Two-stage reimplantation, with interval antibiotic-impregnated cement spacer, is the preferred treatment of prosthetic knee joint infections. In medically compromised hosts with prior failed surgeries, the outcomes are poor. Articulating spacers in such patients render the knee unstable; static spacers have risks of dislocation and extensor mechanism injury. We examined 58 infected total knee arthroplasties with extensive bone and soft tissue loss, treated with resection arthroplasty and intramedullary tibiofemoral rod and antibiotic-laden cement spacer. Thirty-seven patients underwent delayed reimplantation. Most patients (83.8%) were free from recurrent infection at mean follow-up of 29.4 months. Reinfection occurred in 16.2%, which required debridement. Twenty-one patients with poor operative risks remained with the spacer for 11.4 months. All patients, during spacer phase, had brace-free ambulation with simulated tibiofemoral fusion, without bone loss or loss of limb length.
authors.affiliation: University of Chicago, New York, New York 10021, USA.
authors.forename: Suhel Y
authors.initials: SY
authors.lastname: Kotwal
authors.forename: Yasser R
authors.initials: YR
authors.lastname: Farid
authors.forename: Suresh S
authors.initials: SS
authors.lastname: Patil
authors.forename: Kris J
authors.initials: KJ
authors.lastname: Alden
authors.forename: Henry A
authors.initials: HA
authors.lastname: Finn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation* / Q000379:methods*; D001843:Bone Cements; D001858:Bone Nails; D002908:Chronic Disease; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016268:Internal Fixators; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements