An Innovative Static Spacer Utilizing Ilizarov Threaded Rods for 2-Stage Knee Revision Arthroplasty

Background: Knee replacements are among the most common orthopedic surgeries. Periprosthetic joint infection (PJI) is a devastating complication that can occur after total knee replacement, and a 2-stage approach is considered the gold standard for managing it. Static spacers are often used for patients with medical comorbidities that affect wound healing. This study introduces a new technique that employs a static spacer with threaded rods for a 2-stage revision. Methods: Between July 2022 and June 2024, 7 patients with knee PJI were treated using a static spacer made with threaded Ilizarov rods. The average age of the patients was 70 years (range: 64 to 79). All patients had significant medical comorbidities, and 6 out of 7 were culture-positive for PJI. Patient outcomes were assessed based on wound healing, weight-bearing capacity, and the success of second-stage revision. Results: All wounds healed successfully after the static spacer was inserted. Five patients were able to weight-bear with protection after the first-stage revision. All patients underwent second-stage revision successfully. One patient was converted to a non-articulated spacer with a gastrocnemius flap for soft tissue cover. Conclusion: The static spacer with threaded rods is a cost-effective and efficient interim prosthesis for the first stage of a 2-stage revision for PJI. This technique minimizes impact during insertion and allows for easy rod removal in the second stage, making it a practical option for medically complex patients.