The Difficult Primary Total Knee Arthroplasty.

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Abstract

[Indexed for MEDLINE] 15. J Orthop Res. 2023 Jul;41(7):1383-1396. doi: 10.1002/jor.25570. Epub 2023 May 3. Selecting a high-dose antibiotic-laden cement knee spacer. Hollyer I(1), Ivanov D(1), Kappagoda S(2), Lowenberg DW(1), Goodman SB(1), Amanatullah DF(1). Author information: (1)Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA. (2)Division of Infectious Diseases and Geographic Medicine, Stanford Univeristy, Stanford, California, USA. Prosthetic joint infection [PJI] after total knee arthroplasty (TKA) remains a common and challenging problem for joint replacement surgeons and patients. Once the diagnosis of PJI has been made, patient goals and characteristics as well as the infection timeline dictate treatment. Most commonly, this involves a two-stage procedure with the removal of all implants, debridement, and placement of a static or dynamic antibiotic spacer. Static spacers are commonly indicated for older, less healthy patients that would benefit from soft tissue rest after initial debridement. Mobile spacers are typically used in younger, healthier patients to improve quality of life and reduce soft-tissue contractures during antibiotic spacer treatment. Spacers are highly customizable with regard to antibiotic choice, cement variety, and spacer design, each with reported advantages, drawbacks, and indications that will be covered in this article. While no spacer is superior to any other, the modern arthroplasty surgeon must be familiar with the available modalities to optimize treatment for each patient. Here we propose a treatment algorithm to assist surgeons in deciding on treatment for PJI after TKA. © 2023 Orthopaedic Research Society. DOI: 10.1002/jor.25570