Surgical Techniques for Staged Revision of the Chronically Infected Total Knee Arthroplasty

Infection after total knee arthroplasty is a rare yet devastating complication requiring multiple hospitalizations, operations, and outpatient visits placing a significant burden on both patient and treating surgeon. Two-stage exchange protocols for the treatment of the chronically infected total knee arthroplasty remain the standard of care in the United States. Thorough debridement, use of antibiotic spacers, treatment with parenteral antibiotics, and delayed reimplantation have resulted in treatment success rates greater than 90%. The use of antibiotic cement spacers has led to increased range of motion, preservation of the joint space, and maintenance of cleaner soft tissue plains making surgery at the time of reimplantation less arduous. This article describes our current surgical technique used for two-stage revision of the chronically infected total knee including: (1) exposure, (2) implant removal and debridement, and (3) construction of both static and mobile antibiotic spacers.