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Related Experiment Video

Updated: Dec 10, 2025

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report
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How I do it: 1st stage revision TKA.

A J Porteous1

  • 1Avon Orthopaedic Centre, North Bristol NHS Trust, UK.

The Knee
|August 30, 2020
PubMed
Summary

This guide details the first stage of revision Total Knee Arthroplasty (TKA), emphasizing thorough debridement for infection clearance. Mobile spacers are recommended for better patient function, unless significant bone loss or extensor mechanism compromise exists.

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Articles linked to this work by shared authors, journal, and citation graph.

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Same author

Investigation of the problematic knee replacement.

The Knee·2020
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Revision knee complexity classification (RKCC).

The Knee·2020
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Systematic review of learning curves in robot-assisted surgery.

BJS open·2020
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Revision knee complexity classification-RKCC: a common-sense guide for surgeons to support regional clinical networking in revision knee surgery.

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA·2019
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The Avon patellofemoral joint arthroplasty: two- to 18-year results of a large single-centre cohort.

The bone & joint journal·2018
Same author

Survivorship and clinical outcome of the minimally invasive Uniglide medial fixed bearing, all-polyethylene tibia, unicompartmental knee arthroplasty at a mean follow-up of 7.3years.

The Knee·2016

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.
Keywords:
1st stage revisionInfected knee arthroplastySpacers

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