The modified static spacers using antibiotic-impregnated cement rod in two-stage revision for infected total knee arthroplasty

Abstract

The two-stage exchange arthroplasty (one- or two-stage) is believed to be the gold standard for the management of infections following total knee arthroplasty. We herein report a novel two-stage exchange arthroplasty technique using an antibiotic-impregnated cement intramedullary nail, which can be easily prepared during surgery using a straight thoracic tube and a Steinmann pin, and may provide additional stability to the knee to maintain normal mechanical axis. In addition, there is less pain between the period of prosthesis removal and subsequent reimplantation. Less soft tissue contracture, less scar adhesion, easy removal of the cement intramedullary nail, and successful infection control are the advantages of this technique.

Keywords: Antibiotic-impregnated cement; Cement rod; Infection; Static-spacer; Total knee arthroplasty; Two-stage reimplantation.

Fig. 1

(A) Preparation of the Steinmann pin and 36 Fr-diameter silicone tube. (B) Filling of the 50 mL enema syringe with the antibiotic-imprgnated cement. (C) Peeling off the tube.

Fig. 2

Intramedullary nailing technique with the cement-impregnated rod. (A) Insertion of the cement-impregnated nail into the medullary canals of the femur and tibia, and approximation of the joint line and space with a previously marked line on the nail. (B) During this procedure, an assistant is needed to maintain sufficient joint space and anatomic alignment. (C) Covering the proximal tibia and distal femur with antibiotic-impregnated cement. (D) Filling the joint space with cement around the nail. (E) Filling the suprapatellar pouch, medial and lateral gutter space with cement to reduce soft tissue adhesion.

Fig. 3

A 76-year-old female with chronic deep infection 18 months after primary total knee arthroplasty. (A) Immediate postoperative plain radiograph at the first-stage operation with the antibiotic-impregnated cement intramedullary nailing in situ. Good anatomic alignment and sufficient joint space were achieved. (B) Plain radiograph at the immediate postoperative period of the second-stage reimplantation with stem extension.