How I do it — Second stage revision total knee arthroplasty

Infection is a potentially devastating complication following primary total knee arthroplasty, and the traditional gold-standard treatment for chronic prosthetic joint infection has been in the form of a two-stage revision total knee arthroplasty. This involves a first stage – removal of all implants and infected material, with implantation of a temporary spacer – followed by a second stage which includes reimplantation with a definitive prosthesis.

Although the outcomes of single-stage and two-stage revision arthroplasty surgeries are similar, there are certain indications such as atypical or more virulent organisms, patient factors and soft tissue factors that would favour a two-stage approach.

The second stage revision procedure consists of explantation of the spacer with a debridement and synovectomy. Further samples are sent for microbiological analysis. Once the surgical field is clean and lavaged, the definitive prosthesis is implanted.

A second stage revision total knee arthroplasty is a reliable procedure for the treatment of chronic prosthetic joint infection. There is a significant re-revision rate, predominantly due to recurrent deep infection.