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INTRODUCTION: Management of infected total knee arthroplasty (TKA) is a challenge to patient and surgeon alike. Two-stage exchange is the universally acclaimed method to tackle this problem. Various spacer devices are available for the first stage surgery for local delivery of antibiotics. Here, we report our experience with management of infected TKA patients with our indigenously designed and produced knee spacer. CASE REPORT: Between 2012 and 2013, 28 patients with infected total knee replacement (TKR) have been managed by our indigenous knee spacer. Minimal spacer-related complications and a stable knee joint with range of motion up to 100° were noted in these patients. After a mean period of 6-8 weeks, the spacer was removed and definitive TKR fixation done. At a mean follow-up of 4-months post second stage definitive surgery, patients were infection free with no evidence of recurrence of infection. CONCLUSION: Our new innovative customized articulating knee spacer, which has intramedullary stem extension, has potential to significantly reduce spacer-related complications along with providing improved knee function.
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BACKGROUND: Failed intertrochanteric fractures in elderly patients are surgical challenge with limited options. Hip arthroplasty is a good salvage procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. MATERIALS AND METHODS: 30 patients of failed intertrochanteric fractures where hip arthroplasty was done between May 2008 and December 2011 were included in study. 13 were males and 17 were females with average age of 67.3 years. There were 2 cemented bipolar arthroplasties, 19 uncemented bipolar, 4 cemented total hip arthroplasty and 5 uncemented total hip arthroplasties. 16 patients had a trochanteric nonunion, which was treated by tension band principles. Total hip was considered where there was acetabular damage due to the penetration of implant. RESULTS: The average followup was 20 months (range 6-48 months). Patients were followed up from 6 to 48 months with average followup of 20 months. None of the patients were lost to followup. There was no dislocation. All patients were ambulatory at the final followup. CONCLUSION: A predictable functional outcome can be achieved by hip arthroplasty in elderly patients with failed intertrochanteric fractures. Though technically demanding, properly performed hip arthroplasty can be a good salvage option for this patient group.
