Temporary arthrodesis through static spacer implantation in two-stage treatment of periprosthetic joint infections of the knee.

Abstract

Treatment of chronic periprosthetic joint infection of the knee requires the removal of the implant and thorough debridement, with reimplantation in asecond stage surgery. Intramedullary spacers can be helpful during the interval between explantation and reimplantation and provide atemporary arthrodesis which fixes the knee in extension preserving leg length and administers local antibiotic therapy. Periprosthetic joint infection of the knee with large bony defects and severe infection of the native joint with advanced destruction/infiltration of the cartilage and bone and/or ligament insufficiency. Suspected antibiotic resistance of the microbiological pathogen to local antibiotic drugs, incompliant patient, and known allergy to bone cement or antibiotic. After implant removal, suitable metal rods are coated with antibiotic-loaded bone cement and inserted into the cleaned intramedullary canals of femur and tibia. Rods are joined at the joint line with aconnector and joint space is filled with more bone cement to achieve temporary and very stable arthrodesis. Partial weight-bearing and no flexion/extension while spacer is in place; second stage reimplantation as soon as infection is controlled. Complications related to the spacer were rare (5.3%). Reimplantation of an implant was possible in 95 of 113patients (84%), of those, 23 (20%) received an arthrodesis. Of the 95patients that were reimplanted, 14 showed signs of recurrent infection. Mean time to last follow-up was 15.6months post reimplantation. Mean knee pain was 2.9/10; overall function was good; 6patients had an extension lag; mean total range of motion was 88°.