The Truth About Intramedullary Dowels in Chronically Infected Knee Replacements

A data-driven look at why surgeons should reconsider the time-consuming process of constructing intramedullary dowels during stage one resections.

Two-stage treatment of periprosthetic knee infection employs either articulating or static high-dose antibiotic-eluding tibiofemoral cement spacers between resection and reimplantation, with or without antibiotic-eluding intramedullary (IM) dowels. Systematic reviews comparing articulating and static spacers do not address IM dowels but do provide general consensus that the 2 spacer types equivalently eradicate infection, although articulating designs result in improved range of motion and function following reimplantation.

After review and consideration of the available evidence, the 2018 International Consensus Meeting on Periprosthetic Joint Infection recommended the use of articulating spacers unless static spacers are indicated by severe bone loss, ligament insufficiency, or soft tissue compromise; however, the International Consensus group did not comment on the use of IM dowels to enhance treatment and facilitate the eradication of infection.