Description
This presentation by Donald Garbuz discusses the approach to chronically infected knee replacements, focusing on the evolution from traditional two-stage exchange to a more modern methodology utilized in Vancouver. Garbuz outlines the historical context where a two-stage exchange was considered the gold standard for treating infected knee replacements, explaining the limitations and challenges patients face post-surgery during the interim stages, including stiffness and pain.
He presents a shift to articulated spacers, which facilitate better mobility and comfort for patients, allowing them to weight bear while treating infections with high doses of localized antibiotics. He introduces the concept of the 'prostalac of the knee', a prosthetic technique focused on infection control and patient functionality, showcasing positive outcomes from a significant follow-up study.
However, due to the discontinuation of a manufacturing partnership and successful results from one-stage exchanges reported elsewhere, Garbuz describes a transition to an inadvertent one-stage exchange technique. This involves using a new femoral component and high-dose antibiotic cement but emphasizes the importance of stable constructs.
Garbuz shares clinical experiences, including a case study illustrating the practical challenges faced, such as tibial loosening. He concludes with insights into the balance between infection control and patient outcomes, advocating for an adaptable approach to knee revision surgeries while highlighting the long-term positive results seen since adopting these new techniques in Vancouver.