Technical Notes and Tips: Poly-Methylmethacrylate Soft-Tissue Spacers to Maintain Tissue Planes During Two-Stage Revision Knee Arthroplasty

Abstract

Two-stage revision surgery is considered to be the reference standard for deep infections following total knee arthroplasty. Even with the use of preformed mobile poly-methylmethacrylate (PMMA) spacers at first stage revision, the scarring seen at second stage frequently obliterates the suprapatellar pouch and the gutters. Re-forming these planes prior to re-implantation is time-consuming. Following debridement and after fitting the mobile spacers we mould spacers from antibiotic-loaded PMMA cement and place these in the suprapatellar pouch and in the gutters (Fig. 1). At second stage, it is found that these planes are well preserved, facilitating the procedure. Figure 1A Anteroposterior (A) radiograph taken after first stage revision demonstrating the PMMA implants and soft-tissue spacers. Figure 1B Lateral radiograph taken after first stage revision demonstrating the PMMA implants and soft-tissue spacers.