Abstract
The aim of this study was to measure intra-articular gentamicin levels at the 2nd stage revision following the use of an antibiotic impregnated articulating spacer.
Infected total knee replacements are a cause of considerable morbidity often requiring revision in two stages. Rings of bone cement, cement moulds and spacer devices are available for use following the initial debridement and removal of infected metalwork. The availability of antibiotic impregnated articulating spacers are potentially attractive to achieve a high local dose of antibiotic and to maintain a good range of movement.
Seven patients underwent a two stage revision of their total knee replacements. Following the initial debridement an antibiotic impregnated articulating spacer was cemented in place. At the 2nd stage revision a perioperative joint aspirate and blood sample was taken and gentamicin levels measured. The range of movement was assessed.
The average gentamicin levels were 0.72mg/l (0.24 – 2.36mg/l). A good range of movement was maintained in all cases. At these levels the gentamicin would be therapeutic.
Antibiotic impregnated articulating spacers possess several potential advantages to the revision knee surgeon by helping maintain the range of movement and provide local release of antibiotics. Their use should be considered in such cases.
Correspondence should be addressed to Mr Tim Wilton, BASK at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
