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
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Step-by-Step Technique
1
Stage 1 - Resection:
2
Extensile exposure if needed (quadriceps snip, TTO)
3
Remove all components and cement
4
Radical synovectomy
5
Multiple tissue cultures (5-6 specimens)
6
Pulse lavage extensively
7
Static or articulating antibiotic spacer
8
Articulating spacer preferred - maintains ROM and soft tissue tension