Borggreve-Van Nes rotationplasty for infected knee arthroplasty – a case report

A 62-year-old patient presented with a recurrence of infection of the left knee following a two-stage TKA reimplantation for the treatment of a late infection of a TKA implanted in 1995. He had had a right knee arthroplasty in 2004, with good function. The new infection was treated by a debridement, the revision prosthesis was removed, and a cement spacer was placed in the 10-cm bone defect (Figure 1). The tibia tubercle and part of the cement spacer were exposed by an anterior 15-cm2 soft tissue defect. Cultures from the wound taken during the procedure showed a monomicrobial infection with methicillin-resistant coagulase-negative staphylococcus. The patient was treated with intravenous vancomycin. A second look 1 week later showed further deep soft tissue necrosis, probably due to cement heat during the polymerization phase of the spacer, as well as further bone necrosis in the distal femur, the proximal tibia, and the osteotomized tibia tubercle. Therapeutic options, which were discussed with the patient, included arthrodesis, resection arthroplasty (joint resection without joint replacement), amputation, or a rotationplasty (Christie et al. 2003). The patient elected to have a rotationplasty after having seen pictures of a patient who had had a rotationplasty and after having been informed about the expected functional outcome (Fuchs et al. 2003).