Two stage revision knee arthroplasty for infection with massive bone loss. A technique to achieve spacer stability

We report a technique for the intra-operative production of an antibiotic-impregnated cement spacer, reinforced with an intramedullary nail. The spacer is designed for use in cases where significant bone loss and/or ligamentous instability prevent the formation of a stable joint when using a conventional spacer during a two-stage revision knee arthroplasty. This technique has been performed in eleven patients. Nine patients have subsequently undergone a second-stage procedure. Two patients died of unrelated causes before a second-stage could be performed. In all but one case, the infection has been successfully eradicated and patients remain infection free at a mean follow-up of 32 months (range 21-64 months). We believe that the described technique is an effective alternative to the traditional spacer, in patients with significant bone loss and/or ligamentous instability. It delivers antibiotics locally, while producing a mechanically stable joint, on which the patient can mobilise, maintaining leg length and tissue tensions.