How I do it: 1st stage revision TKA.

Area of Science:

• Orthopaedic Surgery
• Infectious Disease Management

Background:

• Revision Total Knee Arthroplasty (TKA) is complex, requiring careful staging for infection control.
• Effective management of periprosthetic joint infections (PJIs) is crucial for successful outcomes.

Purpose of the Study:

• To outline the critical steps and decision-making processes for the first stage of a two-stage revision TKA protocol.
• To provide detailed techniques for spacer creation and selection in revision TKA.

Main Methods:

• Focus on meticulous surgical debridement as the primary step for infection clearance.
• Utilizing antibiotic-impregnated spacers (mobile vs. static) to deliver targeted antibiotics and provide stability.
• Detailed documentation of soft tissues, bone loss, and extensor mechanism status for second-stage planning.

Main Results:

• Infection clearance is achievable with both mobile and static spacers.
• Mobile spacers offer superior patient mobility and function compared to static spacers.
• Spacer complications can lead to premature re-operation, highlighting the importance of technical precision.

Conclusions:

• A well-executed first-stage revision TKA, with appropriate spacer selection and debridement, is essential for successful two-stage treatment.
• Mobile spacers are preferred when feasible, balancing infection control with patient function.
• The timing of the second stage should be determined by clinical assessment and patient readiness.