Antibiotic impregnated total femur spacers: a technical tip

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Infectious Diseases

Background:

• Simultaneous prosthetic joint infection of ipsilateral hip and knee arthroplasties presents significant bone loss.
• This condition poses a complex reconstructive challenge for orthopedic surgeons.
• Current treatment often involves two-stage reconstruction, necessitating specialized femoral spacers.

Purpose of the Study:

• To describe a novel surgical technique for creating a custom total femur antibiotic-impregnated spacer.
• To evaluate the utility of this custom spacer in managing severe bone loss associated with infected hip and knee arthroplasties.

Main Methods:

• A custom total femur spacer was fabricated by connecting an articulating hip spacer and an articulating knee spacer.
• A reinforced cement dowel construct was utilized to join the hip and knee spacer components.
• The technique was applied in two cases involving simultaneous ipsilateral hip and knee prosthetic joint infections with substantial femoral bone loss.

Main Results:

• The described surgical technique successfully created a custom antibiotic-impregnated total femur spacer.
• This custom spacer effectively managed the complex reconstructive problem in the reported cases.
• The method addresses the lack of commercially available total femur spacers for such indications.

Conclusions:

• Custom total femoral spacers are a viable and useful solution for infected femoral megaprostheses.
• This technique is particularly beneficial in cases of simultaneous ipsilateral hip and knee arthroplasties with severe femoral bone loss.
• The described method offers a reconstructive option for challenging orthopedic infections involving extensive bone defects.