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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


Infected TKA is one of the most challenging complications of knee surgery, but spacers can make them easier. An articulating spacer allows partial weight bearing and range of motion of the knee during rehabilitation. This spacer is made using antibiotic-impregnated bone cement applied to the implant. For our purpose, 4.8 g powdered tobramycin is mixed with 2 g vancomycin and one batch of cement. Cement is applied early to the components, but applied late to the femur, tibia, and patella to allow molding to the defects and bone without solid adherence to bone. Patients have tailored intravenous antibiotic therapy for 6 weeks for treatment of various gram-positive and gram-negative organisms. At 10–12 weeks patients receive a cemented revision total knee arthroplasty using standard cementing techniques. From our experience range of motion before reimplantation is 5–90 degrees. Follow-up averaged 73 months for 50 patients with 90% good to excellent results, 10% may have a recurrence. Use of an articulating spacer achieves soft tissue compliance, allows for ease of operation, reduced post-operative pain, improved function, and eradicates infection equal to standards reported in the literature.