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A Mini-Invasive Internal Fixation Technique for Studying Immobilization-Induced Knee Flexion Contracture in Rats
Published on: May 20, 2019
Intramedullary rod and cement static spacer construct in chronically infected total knee arthroplasty
Suhel Y Kotwal1, Yasser R Farid, Suresh S Patil
1University of Chicago, New York, New York 10021, USA.
The Journal of Arthroplasty
|July 26, 2011
Summary
This study shows that using an antibiotic-loaded cement spacer with an intramedullary rod is effective for treating infected knee replacements, even in complex cases. Most patients achieved infection-free outcomes, with many able to walk without braces during treatment.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Prosthetic knee joint infections are challenging, especially in medically compromised patients.
- Traditional two-stage reimplantation with antibiotic spacers has poor outcomes in complex cases.
- Existing spacer designs (articulating, static) present risks like instability, dislocation, and extensor mechanism injury.
Purpose of the Study:
- To evaluate the efficacy of resection arthroplasty with an intramedullary tibiofemoral rod and antibiotic-laden cement spacer for infected total knee arthroplasties.
- To assess outcomes in patients with extensive bone and soft tissue loss, including those with poor operative risks.
- To determine the rate of recurrent infection and functional outcomes during the spacer phase.
Main Methods:
- A retrospective analysis of 58 infected total knee arthroplasties.
- Treatment involved resection arthroplasty, intramedullary tibiofemoral rod, and an antibiotic-laden cement spacer.
- Patients were divided into those undergoing delayed reimplantation and those remaining with the spacer due to poor operative risk.
Main Results:
- 83.8% of patients were free from recurrent infection at a mean follow-up of 29.4 months.
- Reinfection occurred in 16.2% of cases, necessitating debridement.
- Patients with the spacer achieved brace-free ambulation with simulated tibiofemoral fusion, maintaining limb length and without further bone loss.
Conclusions:
- Resection arthroplasty with an intramedullary tibiofemoral rod and antibiotic-laden cement spacer is a viable and effective treatment for complex infected total knee arthroplasties.
- This approach offers good infection control and functional ambulation, even in high-risk patients or those with significant bone/soft tissue loss.
- The technique provides a stable, infection-controlled interim solution, facilitating delayed reimplantation or serving as a definitive treatment in compromised hosts.