The Use of Spacers in Two-Stage Revision Total Knee Arthroplasty: Indication and Surgical Technique - Honorable Mention
Two-stage revision for septic total knee arthroplasty is commonly performed. Spacers play a crucial role in this surgical technique. This video describes the indication, surgical technique, and outcomes of two-stage revision total knee arthroplasty with the use of static and articulating spacers. Static spacers are indicated in patients with severe ligamentous instability, wound healing problems, insufficient extensor apparatus, or massive bone loss. The main disadvantages of static spacers are the risk of joint stiffness, poor range of motion, and increased bone loss during the second stage. Static spacers are prepared using two Steinmann pins covered with antibiotic-loaded cement and are used as intramedullary rods. A U-shaped posterior block made with antibiotic-loaded cement is prepared and positioned posteriorly to maintain joint tension. The rods previously prepared are inserted, and the construct is covered with antibiotic-loaded cement. A small amount of antibiotic-loaded cement also is applied in the suprapatellar pouch to prevent scar formation between the femur and the extensor apparatus. Articulating spacers are most commonly used in two-stage revision total knee arthroplasty. In some patients, such as those with wound problems or extensor apparatus incompetence, a static spacer may be indicated. Articulating spacers are classified based on the interface as cement-on-cement, prosthesis-on-polyethylene, or metal-on-polyethylene spacers. Cement-on-cement spacers are most commonly used, and they can be molded or preformed. No clear advantages of one spacer over another exist; therefore, spacer selection is based on surgeon preference. This video shows two-stage revision total knee arthroplasty with the use of preformed spacers. Dislocation is a possible complication associated with articulating spacers. To prevent dislocation, two Steinmann pins can be covered with antibiotic-loaded cement and used as intramedullary rods. Studies comparing static and articulating spacers reported no difference with regard to infection eradication; however, better range of motion, reduced joint stiffness, and easier second stage were associated with articulating spacers.