Abstract
The infected TKA is one of the most challenging complications of knee surgery, but spacers can make them easier to treat. An articulating spacer allows weight bearing and range of motion of the knee during rehabilitation. This spacer is made using antibiotic-impregnated bone cement applied to the tibial and femoral implant. For our purpose, 4.8g powdered tobramycin is mixed with 2g 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 are revised to a cemented revision total knee arthroplasty using standard cementing techniques. From our experience, range of motion before reimplantation was 5 – 90 degrees. Follow-up averaged 73 months for fifty patients with 90% good to excellent results; 10% had a recurrence of infections. Use of an articulating spacer achieves soft tissue compliance, allows for ease of re-operation, reduced post-operative pain, improved function, and eradicates infection equal to standards reported in the literature.
