D.V. RIMASHEVSKIY², E.T. KURMANGALIYEV², I.F. AKHTIAMOV¹, H.Z. MAKAZHANOV³, A.A. BELOKOBYLOV³, A.E. ALI^3,4, A.A. ALIBEKOV^3,5

¹Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan, 138 Orenburgskiy Trakt, Kazan, Russian Federation, 420064

²Karaganda region Center for Traumatology and Orthopedics named after Prof. Kh.Zh. Makazhanov, 13 Saken Seifullin Prospekt, Karaganda, Republic of Kazakhstan, 100019

³Scientific-Research Institute for Traumatology and Orthopedics of Kazakhstan Republic, 15а Abylai khan St., Astana, Republic of Kazakhstan, 010000

⁴City Clinical Hospital № 4, 220 Papanin St., Almaty, Republic of Kazakhstan, 050039

⁵Oblast Clinical Hospital, 85 Savichev St., Uralsk, Republic of Kazakhstan, 090000 

Rimashevskiy D.V. — consultant, tel. +7-909-943-06-18, e-mail: drimashe@gmail.com²

Kurmangaliyev E.T. — Vice Chief Doctor, tel. +7-701-426-22-10, e-mail: dakekz@mail.ru²

Akhtyamov I.F. — D. Med. Sc., Professor, Head of the Department oа Traumatology, Orthopedics and Urgent Surgery of Kazan State Medical University, Chief Researcher of Scientific Department of Republican Clinical Hospital, tel. +7-905-315-01-50, e-mail: yalta60@mail.ru¹

Belokobylov A.A. — Head of the Department of Replacement Arthroplasty, tel. +7 (7172) 54-77-17²

Ali A.E. — applicant of Scientific-Research Institute for Traumatology and Orthopedics, traumatologist – orthopedist of City Clinical Hospital № 4, tel. +7 (727) 300-36-04, e-mail: info@gkb4.kz^3,4

Alibekov A.A. — applicant of Scientific-Research Institute for Traumatology and Orthopedics, traumatologist – orthopedist of Oblast Clinical Hospital, tel. +7 (7112) 26-62-71, e-mail: zkoblbolnica@yandex.ru^3,5

The aim of work is to implement into clinical practice the modular spacer at the first stage of treating the infectious complications of knee arthroplasty.

16 cases of two-stage revision of septic total knee prosthesis, performed by the authors in 2011 — 2013, were retrospectively evaluated. The key element of the method was the use of a modular bone cement spacer loaded with antibiotics. Its constructive features were: presence of intramedullary, femoral and tibial (insert-like) components; tibial component stabilization by protruding part of tibial intramedullary spacer; press-fit femoral spacer implantation. Modular spacer allowed to perform effective local antibiotic therapy. Infection was eradicated in 87.5% of cases (14 out of 16). In none of the cases, bone deficit progression was seen.

The authors conclude that during the first stage of knee revision, the intramedullary canal spacers should be implanted in both femur and tibia. Femoral spacer and insert-like spacer should be stabilized without cementing.

Key words: periprosthetic infection, revision joint replacement, spacer.

 

 

REFERENCES

1. Bozic K.J., Kurtz S.M., Lau E., Ong K. et al. The epidemiology of revision total knee arthroplasty in the United States. Clin. Orthop. Relat. Res., 2010, Jan., no. 468 (1), pp. 45-51.

2. Parvizi J., Adeli B., Zmistowski B., Restrepo C. et al. Management of Periprosthetic Joint Infection: The Current Knowledge: AAOS Exhibit Selection. J. Bone Joint Surg. Am., 2012, no. 94 (14), pp. 1041-9.

3. Schnettler R., Steinau H.U. Septic bone and joint surgery. Thieme Medical Pub., 2010.

4. Scuderi G.R., Tria A.J., Knee Arthroplasty Handbook. Techniques in Total Knee and Revision Arthroplasty. 2006, Springer Science+Business Media, Inc. ISBN-10: 0-387-30730-3, ISBN-13: 978-0387-307305:120-132.

5. Kaya I., Sungur I., Yimazi M.,Pehlivanoglu F., Kartyafiar K., Sengos A. Comparison of the efficiency of different antibiotic irrigation solutions in decontamination of allografts contaminated with Staphylococcus aureus. Acta Orthop. Traumatol. Turc., 2013, no. 47(4), pp. 281-285.

6. Amin T.J., Lamping J.W., Hendricks K.J, McIff T.E. Increasing the Elution of Vancomycin from High-Dose Antibiotic-Loaded Bone Cement: A Novel Preparation Technique. J. Bone Joint Surg. Am., 2012, Nov. 07, no. 94 (21). pp. 1946-1951.

7. Osmon D.S., Berbari E.F., Berendt A.R., Lew D. et al. Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases, 2013, 56 (1), pp. 1-25.