Two-Stage Revision for Periprosthetic Joint Infection - Knee
intermediate Level
Primary Indication
Chronic periprosthetic joint infection TKA
Danger Structures
Sciatic nerve - 15-30mm posterior to hip joint depending on approach and position, injury causes foot drop and sensory loss - EXAM KEY: identify and protect, keep hip flexed to relax nerve
Femoral neurovascular bundle - 30-50mm medial to anterior hip joint, injury catastrophic - EXAM KEY: stay on bone with anterior retractors
Superior gluteal neurovascular bundle - 30-50mm proximal to greater trochanter, injury causes abductor weakness - EXAM KEY: avoid proximal dissection, stay in safe zone
Lateral femoral cutaneous nerve - variable position 20-50mm from anterior incisions, injury causes meralgia paresthetica - EXAM KEY: protect when visible
Medial femoral circumflex artery - main blood supply to femoral head, at risk during capsulotomy - EXAM KEY: careful dissection around posterior femoral neck
Visual Atlas
No anatomy Images Yet
We're currently sourcing high-quality anatomy diagrams for this procedure.
Step-by-Step Technique
1
Stage 1 - Resection:: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
2
Extensile exposure if needed (quadriceps snip, TTO): EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
3
Remove all components and cement: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
4
Radical synovectomy: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
5
Multiple tissue cultures (5-6 specimens): EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
6
Pulse lavage extensively: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
7
Static or articulating antibiotic spacer: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
8
Articulating spacer preferred - maintains ROM and soft tissue tension: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
9
Handmade or commercial (PROSTALAC, etc.): EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
10
High-dose antibiotics in cement: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
11
IV antibiotics 6 weeks minimum: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
12
Monitor ESR/CRP: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
13
Stage 2 - Reimplantation:: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Malposition of hardware
Damage to adjacent structures
14
After antibiotic holiday and normalized markers: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
15
Joint aspiration if any doubt: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
16
Remove spacer, thorough debridement: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
17
Intraoperative frozen section: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Iatrogenic injury to adjacent structures
18
Implant revision TKA components with stems: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.
Danger Zone
Malposition of hardware
Damage to adjacent structures
19
Antibiotic cement fixation: EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.'
Surgeon's Tip
EXAM KEY: 'This step is critical for Unknown success - understand anatomical relationships and potential complications.