65 years old gentleman, a case of bilateral total knee replacement operated 7 yrs. back came with complaints of discharge from surgical site on the right knee after 9 months of index surgery. Initially he was treated with debridement and antibiotics but discharge didn’t settle down.
Thereafter he underwent stage 1 revision total knee replacement where prostalac (antibiotic loaded cement spacer) was inserted and put on antibiotics, IV followed by oral for around 3 months.
After the infection markers became normal, stage 2 revision was performed whereby the space was removed and hinged knee prosthesis was inserted.
Patient is now comfortable and walking with support. These periprosthetic joint infection cases need to be addressed meticulously and are highly challenging both for the patient (burden of number of surgeries) and the surgeon (technically demanding). As previous prosthesis removal leads to loss of bone stock and adequate debridement requires sacrifice of collateral ligaments, thus hinge knee prosthesis are required to restore the mobility. We routinely performed such revision surgeries.