FEATURED SURGERY: Use of an Articulating Antibiotic Spacer and Dowel in Resection of an Infected TKA

    In a pre-recorded surgery presented at ICJR’s 13th Annual Winter Hip & Knee Course, R. Michael Meneghini, MD, performs the first stage of a 2-stage revision total knee arthroplasty (TKA) in an 83-year-old female patient with diabetes mellitus and a history of recurrent urinary tract infections (UTI).

    RELATED: Using Articulating Spacers in a 2-Stage Revision, a Surgical Techniques article

    Five years prior, Dr. Meneghini had performed the patient’s primary TKA, which had required the use of augments for significant medial bone loss. She had been doing well but then developed pain in the operated knee. She delayed seeking treatment for 1 month and by the time she saw Dr. Meneghini, her knee was swollen, and she had a markedly elevated C-reactive protein level and erythrocyte sedimentation rate. Knee aspirate grew Escherichia coli, leading to suspicion that the UTIs seeded her knee.

    In the surgical video, Dr. Meneghini demonstrates his aggressive debridement technique and then shows how he uses a preformed articulating antibiotic spacer and dowel to assist in eradicating the infectious organism. The spacer and dowel elute low-dose gentamicin for up to 6 months. He augments this by coating the spacer and dowel with high-dose antibiotic cement consisting of vancomycin and tobramycin.

    In most cases, he removes the spacer and dowel at 3 months for the second stage of the revision, but he says they are durable enough to remain in place for up to a year if the patient is medically unable to undergo the procedure sooner.

    Bryan D. Springer, MD, joined Dr. Meneghini at the podium during the presentation to discuss the case, ask questions about the techniques shown, and provide additional insights as a surgeon with a busy revision practice.

    This surgical broadcast was supported by OsteoRemedies.

    Faculty Bios

    R. Michael Meneghini, MD, is a Professor of Clinical Orthopaedic Surgery at Indiana University School of Medicine, Fishers, Indiana. He is also Director of the IU Hip & Knee Center.

    Bryan D. Springer, MD, is Fellowship Director at OrthoCarolina Hip & Knee Center, Charlotte, North Carolina; a Professor in the Department of Orthopedic Surgery at the Atrium Musculoskeletal Institute; and Medical Director and co-founder of Operation Walk Carolinas. He is also one of the chairs of the 13th Annual Winter Hip & Knee Course.

    Disclosures: Dr. Meneghini has disclosed that he receives royalties from and is a paid consultant for DJO and OsteoRemedies; that he has stock or stock options in Emovi; that he is a paid consultant for 3M+KCI, Kinamed, and Surgical Care Affiliates; and that he had ownership shares in the IU Health Saxony ambulatory surgery center. Dr. Springer has disclosed that he is a paid consultant for ConvaTec, OsteoRemedies, and Stryker and that he is a medical advisor for Joint Purification Systems and Sonoran Biosciences.