title: Treatment of infected nonunion total knee arthroplasty periprosthetic fracture using a stemmed articulating spacer.
abstract: BACKGROUND
  We present a case of multifocal infection involving the left total hip replacement and the right total knee replacement of a patient, further complicated by an infected non-union of a periprosthetic fracture of the right knee. This required the unique simultaneous management of both infection eradication and fracture stabilization in the knee.
  
  
  METHODS
  Both sites were treated with a two-stages procedure, including the novel use of a stemmed articulating spacer for the right knee. This spacer was made combining a retrograde humeral nail, coated with antibiotic-impregnated cement, and a pre-formed articulating cement spacer. The patient was able to weight-bear on this spacer.
  
  
  RESULTS
  The fracture went on to unite, and a second stage was performed with the use of stemmed prosthesis and augments. She remains infection free two years after the second stage operation.
  
  
  CONCLUSIONS
  The use of a stemmed articulating knee spacer can facilitate infection eradication and fracture stabilization while preserving some motion and weight-bearing ability in the two-stages management of an infected periprosthetic fracture of the knee.
  
  
  METHODS
  Level V (Case report).
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors.forename: Hee-Nee
authors.initials: HN
authors.lastname: Pang
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. Electronic address: ben_seah@hotmail.com.
authors.forename: Renyi Benjamin
authors.initials: RB
authors.lastname: Seah
authors.affiliation: Division of Orthopaedic Surgery, Joint Replacement Institute, London Health Sciences Centre, ON, Canada.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: MacDonald
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements; D005260:Female; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000601:surgery*; D019736:Prostheses and Implants; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery; D013212:Staphylococcus epidermidis / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements
keywords: Arthroplasty; Fracture; Infection; Knee; Periprosthetic; Spacer