Handmade articulating spacer for two-stage exchange at the knee.

IF 1 4区医学 Q3 ORTHOPEDICS

Operative Orthopadie Und Traumatologie Pub Date : 2023-06-01 DOI:10.1007/s00064-023-00810-0

Martin Lüdemann, Sebastian von Hertzberg-Bölch, Anna Gurok, Jan Oberfeld, Maximilian Rudert

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引用次数: 0

Abstract

Objective: Two-stage exchange with implantation of a temporary spacer is considered gold standard treatment for chronic periprosthetic joint infection of the knee. This article describes a simple and safe technique for handmade articulating spacers at the knee.

Indication: Chronic or relapsing periprosthetic joint infection of the knee.

Relative contraindications: Known allergy against components of polymethylmethacrylate (PMMA) bone cements or admixed antibiotics. Inadequate compliance for two-stage exchange. Patient not able to undergo two-stage exchange. Bony defect situation at the tibia or femur leading to collateral ligament insufficiency. Soft tissue damage with need for plastic temporary vacuum-assisted wound closure (VAC) therapy.

Surgical technique: Removal of the prosthesis, thorough debridement of necrotic and granulation tissue, tailoring bone cement with antibiotics. Preparation of a tibial and femoral stem. Customizing the tibial and femoral articulating spacer components to bony anatomy and soft tissue tension. Confirmation of correct position by intraoperative radiography.

Postoperative management: Protection of the spacer with an external brace. Restricted weight-bearing. Passive range of motion as possible. Intravenous-followed by oral antibiotics. Reimplantation after successful treatment of infection.

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手工关节垫片为两阶段交换在膝盖。

目的:两阶段假体置换与临时垫片植入被认为是治疗膝关节慢性假体周围关节感染的金标准。这篇文章描述了一个简单和安全的技术手工关节垫片在膝盖。适应症:膝关节假体周围慢性或复发性关节感染。相对禁忌症:已知对聚甲基丙烯酸甲酯(PMMA)骨水泥成分或混合抗生素过敏。两阶段交换的合规性不足。病人不能进行两阶段的交换。胫骨或股骨骨缺损导致副韧带功能不全。软组织损伤需要塑料临时真空辅助伤口闭合(VAC)治疗。手术技术:取出假体，彻底清创坏死和肉芽组织，用抗生素配制骨水泥。准备胫骨和股骨干。定制胫骨和股骨关节间隔部件，以适应骨骼解剖和软组织张力。术中x线片确认正确体位。术后处理:用外支架保护垫片。限制负重。尽可能进行被动活动。静脉注射，然后口服抗生素。感染治疗成功后再植。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Operative Orthopadie Und Traumatologie ORTHOPEDICS-

CiteScore

2.10

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Orthopedics and Traumatology is directed toward all orthopedic surgeons, trauma-tologists, hand surgeons, specialists in sports injuries, orthopedics and rheumatology as well as gene-al surgeons who require access to reliable information on current operative methods to ensure the quality of patient advice, preoperative planning, and postoperative care. The journal presents established and new operative procedures in uniformly structured and extensively illustrated contributions. All aspects are presented step-by-step from indications, contraindications, patient education, and preparation of the operation right through to postoperative care. The advantages and disadvantages, possible complications, deficiencies and risks of the methods as well as significant results with their evaluation criteria are discussed. To allow the reader to assess the outcome, results are detailed and based on internationally recognized scoring systems. Orthopedics and Traumatology facilitates effective advancement and further education for all those active in both special and conservative fields of orthopedics, traumatology, and general surgery, offers sup-port for therapeutic decision-making, and provides – more than 30 years after its first publication – constantly expanding and up-to-date teaching on operative techniques.