First Stage Revision of Infected TKR: A Technique of Handcrafted Articulating Spacers and Cement Pancake Soft Tissue Spacers

Somasekhara Reddy Nallamilli; Rajyalakshmi N Reddy; Mohan Krishna Althuri

doi:10.1007/s43465-022-00739-9

First Stage Revision of Infected TKR: A Technique of Handcrafted Articulating Spacers and Cement Pancake Soft Tissue Spacers

Indian J Orthop. 2022 Oct 6;56(12):2086-2092. doi: 10.1007/s43465-022-00739-9. eCollection 2022 Dec.

Authors

Somasekhara Reddy Nallamilli¹, Rajyalakshmi N Reddy², Mohan Krishna Althuri³

Affiliations

¹ Apollo Hospital, #957, International Pavilion, Jubilee Hills, Hyderabad, 500033 Telangana India.
² Glan Clwyd Hospital, Rhyl, Bodelwyddan, LL18 5UJ UK.
³ Apollo Hospital, Hyderabad, India.

Abstract

This is a study to see if improvised 'articulating antibiotic cement spacers' work in two-stage revisions for infected TKRs with bone defects in the condyles. The second objective is to see if adhesions can be prevented between intra-articular bone and soft tissue around it after the first stage to make exposure of the joint easy and quick in the second stage. Six cases were selected which had moderate defects of femoral or tibial condyles and a modified technique was used to prepare articulating cement spacers. Antibiotic cement moulded like pancakes was placed on the exposed raw areas of the femur and tibia. Patients were mobilised with protected weight-bearing after the surgery and active knee flexion was encouraged. Patients regained a mean of 80 degrees of knee flexion during the interval between the stages and a mean of 100 degrees of flexion following the second stage. There was no bone loss while removing the modified cement spacers. Patients had no significant intra-articular adhesions and hence the exposure of the knee joint during the second stage did not require further intra-articular dissection. Standard articulating spacers are not suitable in the cases with bone loss of the condyles. Our modified technique allowed us to use it in cases with moderate bone loss also where static spacers are used otherwise. This helped to mobilise these knees between the two stages of revision instead of keeping immobilised with static spacers. Antibiotic cement pancakes prevented intra-articular adhesions and carried an extra dose of antibiotic into the joint.

Keywords: Antibiotic cement pancakes to prevent arthrofibrosis; Antibiotic impregnated bone cement Articulating or Static spacers; Dynamic cement spacers for bone loss in infected TKR; Soft tissue spacers; Two-stage revision for the infected total knee replacement.

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