{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T06:15:14Z","timestamp":1783664114683,"version":"3.55.0"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction: Chronic prosthetic joint infection (PJI) with intramedullary extension presents exceptional management challenges in morbidly obese patients. This case demonstrates novel elastic titanium pin spacer fabrication for complex infection control. To the best of our knowledge, this is the first reported case combining intramedullary infection extending to the mid-diaphyseal level with an innovative spacer design.\n\nCase Report: A 60-year-old morbidly obese male, 110 kg, with a body mass index of 44 kg\/m\u00b2, presented with chronic PJI, multiple draining sinuses, and wound dehiscence 14 months post-primary TKA. Multiple previous debridements failed to control infection. Intraoperative findings revealed extensive intramedullary infection extending to the mid-diaphyseal level without implant-cement interface involvement. Two-stage revision was performed using an innovative elastic titanium pin (Ti-6Al-4V, 2 mm \u00d7 200 mm) technique for spacer fabrication and a comprehensive infection management protocol.\n\nResults: Despite culture-negative infections, the staged surgical approach achieved complete infection eradication. Patient achieved full weight-bearing at 1 month with 0\u2013110\u00b0 range of motion. At more than a year's follow-up, he remains symptom-free with stable prosthetic components and no recurrent infection.\n\nConclusion : This case demonstrates successful management of complex PJI with intramedullary extension using a novel elastic titanium pin spacer technique. The unique presentation provides valuable insights for managing similar complex cases in high-risk populations.\n\nKeywords: Prosthetic joint infection, intramedullary infection, elastic titanium pin spacer, morbid obesity, two-stage revision.Prosthetic joint infection, intramedullary infection, elastic titanium pin spacer, morbid obesity, two-stage revision.<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i07.7700","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:34:30Z","timestamp":1783661670000},"page":"389-394","source":"Crossref","is-referenced-by-count":0,"title":["Complex Two-Stage Revision Total Knee Arthroplasty with Intramedullary Infection Management Using Elastic Titanium Pin Spacer Technique in a Morbidly Obese Patient: A Case Report"],"prefix":"10.13107","volume":"16","author":[{"given":"Vinit Kumar","family":"Singh","sequence":"first","affiliation":[{"name":"[1] Department of Orthopaedics, Rama Medical College Hospital and Research Centre, Kanpur, Uttar Pradesh, India [2] Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Pareek","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhairya H.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev","family":"Gupta","sequence":"additional","affiliation":[{"name":"[3] Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India [4] Department of Orthopaedics, ESIC Ghaziabad, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahil B.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:34:32Z","timestamp":1783661672000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/07\/complex-two-stage-revision-total-knee-arthroplasty-with-intramedullary-infection-management-using-elastic-titanium-pin-spacer-technique-in-a-morbidly-obese-patient-a-case-report\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i07.7700","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}