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First Stage Revision Total Knee Replacement for Acute Prosthetic Joint Infection (Zimmer Biomet articulating spacer) Surgical Technique

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Periprosthetic joint infection (PJI) is a devastating complication of prosthetic joint replacement, accounting for 22.5% of 60,671 of revision total knee arthroplasties performed in the UK between 2003-2017.[i]

Surgical management involves identification of the infecting pathogens and optimisation of the host prior to major surgery, which may involve debridement and implant retention, or a single or two-staged revision procedure. Staged revision surgery remains the gold standard of care. At the first stage the prosthetic components are explanted and the involved soft-tissues are radically debrided. The joint is temporarily stabilised with either an articulating cement spacer, as in this case, or non-articulating spacer for approximately 3 months. At the second stage, following repeat debridement, the joint is reconstructed.

The articulating spacer (StageOne Cement Spacer Molds, Zimmer Biomet) permit the delivery of local antibiotics after the initial explantation and debridement whilst preserving some joint motion thus improving patient function and satisfaction between stages and preserving soft-tissue planes for the second stage.

[i] National Joint Registry: National Joint Registry for England and Wales, 14th annual report 2017.  http://www.njrreports.org.uk/Portals/0/PDFdownloads/NJR%2014th%20Annual%20Report%202017.pdf

 

Author: Mr Jonathan Stevenson FRCS (Tr & Orth)

Institution: The Royal Orthopaedic Hospital ,Birmingham ,UK.

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