Antibiotic impregnated total femur spacers: a technical tip

Abstract

Simultaneous prosthetic joint infection of ipsilateral hip and knee arthroplasties is often accompanied by significant bone loss and presents a challenging reconstructive problem. Two-stage reconstruction is favored and requires the placement of a total femur spacer, which is not a commercially available device. We describe a surgical technique, reporting on 2 cases in which a customized total femur antibiotic impregnated spacer was created by combining an articulating knee spacer and an articulating hip spacer with a reinforced cement dowel construct connecting the 2 spacers. Custom total femoral spacers are useful in the management of infected femoral megaprostheses and cases with ipsilateral injected hip and knee arthroplasties and severe femoral bone loss.

Preliminary outcomes of proximal femur megaspacers

“…Recently, Canham et al. [27] and Saez-Ruiz et al. [28] have reported 2 different techniques for the fabrication of total femur megaspacers in patients with total femur bone stock loss.…”

“…We believe that the invasion of the proximal tibia could pose a risk of infection dissemination in a sterile bone. The distal femur resection described by Canhan [27] and Saez-Ruiz [28] brings about new knee instability, thus making it necessary for patients to use a knee orthosis for light toe-touch weight-bearing ambulation. Our spacer design intends to allow full weight-bearing ambulation after 3 weeks (the time required for soft tissue healing).…”

“…Our spacer design intends to allow full weight-bearing ambulation after 3 weeks (the time required for soft tissue healing). The authors [27] , [28] describe a posterolateral approach because of extensile properties. While they perform large approaches that will potentially damage the soft tissue envelope, we intend to preserve it because we believe that it is of capital importance for fracture healing and effective antibiotic delivery.…”

Progress of antibiotic-loaded bone cement in joint arthroplasty

“…[ 85 ] Multi-antibiotic-loaded cement played an essential role in application of a total femur spacer and filling. [ 86 , 87 ] New bone defect filling and cement fixation techniques are still being designed. [ 88 – 91 ] Some questions have developed in the process and remain unsolved.…”

Creating a dual articulating antibiotic spacer for management of an infected total femur prosthesis hemiarthroplasty

“…While initial techniques described in the literature demonstrated articulating hip joints with a fixed knee joint [17], [18], [19], [20], total knee arthroplasty literature has shown improvements in range of motion (ROM) as well as improved soft-tissue management at the definitive surgery when an articulating spacer is used, which has led toward the favoring of a dual articulating spacer [21], [22]. To our knowledge, 3 techniques describing dual articulating total femur spacers have been described to date, with each involving an acetabular cup at the definitive procedure [23], [24], [25]. Here, we present our surgical technique for manufacturing a dual articulating total femur spacer which allows preservation of the native acetabulum using a hemiarthroplasty head, modular proximal femur body, femoral intramedullary nail, and a commercially available injection-molded articulating distal femur.…”