Management of a periprosthetic infection after total left knee replacement using an original method for articulating spacer manufacturing: case study

Periprosthetic infection (PPI) is one of the most severe complications after total knee replacement. While managing patients with chronic deep PPI after total knee replacement, two-stage revision arthroplasty with intermediate installation of an antimicrobial knee joint spacer is used. The advantage of an articulating spacer is the ability to maintain motor activity until reimplantation of a permanent endoprosthesis. However, factory moulds including 3D-printed are not always available in routine clinical practice, given the high cost and limited equipment accessibility. We present a case study of a patient with chronic deep PPI after total left knee replacement. An original method of intraoperative manufacturing of the tibial component of the articulating spacer was used in the course of treatment. The technique involves sterile mould making using a fitting plastic liner and soft polymer mass. Bone cement impregnated with antibacterial drugs is placed into the mould. When the bone cement hardens, a tibial spacer component is ready. The sterilized femoral and fabricated tibial spacer components are implanted using antibiotic-impregnated bone cement. If it is not technically possible to use fitting inserts, a previously removed plastic insert from the endoprosthesis can be used. The developed original method has a number of advantages: individual selection of spacer sizes, independent addition of the required quantity and type of antibacterial drugs, and economic efficiency. Successful infection relief in the patient allowed further revision endoprosthetics with installation of a permanent endoprosthesis.