A Permanent Articulating Spacer Versus Two-Stage Exchange for Chronic Periprosthetic Joint Infection: A Propensity Score-Matched Study

Belay, Elshaday; Wixted, Colleen; Kim, Billy; Wellman, Samuel S.; Jiranek, William A.; Bolognesi, Michael P.; Seyler, Thorsten M.

doi:10.1016/j.arth.2023.01.036

Cited by 5 publications

(9 citation statements)

References 41 publications

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“…An additionally noteworthy result of the present study, although not the main issue, is a reinfection rate of 4.2%, which is lower than previously reported reinfection rates (11-37%) for articulating spacers [1,5,7,17,20,23,30]. This low rate may be attributed to our adherence to reprepping and re-draping the patients before insertion of the articulating spacer.…”

Section: Discussioncontrasting

confidence: 61%

“…Previous studies have shown that 1.5-stage exchange arthroplasty can ensure favourable infection control while preserving knee function, reducing morbidity, and decreasing costs and overall hospital stays. This technique can be applied to PJI without highly speciic indications or concerns of reinfection in the setting of revision prosthesis insertion [1,7,17, However, no studies have adequately evaluated whether 1.5-stage exchange arthroplasty can provide acceptable aseptic survival. Although a previous study has reported the rate for spacer in-situ [7], this study did not robustly analyse the aseptic survival because cases with septic failure were not excluded.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that 1.5‐stage exchange arthroplasty can ensure favourable infection control while preserving knee function, reducing morbidity, and decreasing costs and overall hospital stays. This technique can be applied to PJI without highly specific indications or concerns of reinfection in the setting of revision prosthesis insertion [1, 7, 17, 23]. .…”

Section: Discussionmentioning

confidence: 99%

“…Although two‐stage exchange arthroplasty has traditionally been performed for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA), the morbidity and increased cost associated with the two subsequent major procedures are a concern [7, 17]. One stage exchange arthroplasty has been suggested in this context; however, limitations have emerged in highly specific surgical indications, which can only be performed in cases without severe soft tissue or bony compromise, antibiotic resistance, or uncertain microorganism infection [1, 7, 32]. Additionally, there are concerns regarding reinfection in the setting of robust metaphyseal and diaphyseal fixation of the prosthesis in a one‐stage operation when considering the difficult infection clearance in TKA [7].…”

Section: Introductionmentioning

confidence: 99%

“…This new strategy involves the placement of a functional articulating antibiotic spacer intended to remain indefinitely or until aseptic loosening occurs. Previous studies have reported promising outcomes in terms of infection clearance, cost saving, and clinical outcomes following 1.5‐stage exchange arthroplasty [1, 7, 17, 23]. However, no studies have analysed the aseptic survival of the 1.5‐stage exchange arthroplasty, which is crucial for surgeons.…”

Section: Introductionmentioning

confidence: 99%

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Aseptic survival of the 1.5‐stage exchange arthroplasty for periprosthetic joint infection was acceptable when using an autoclaved femoral component and a new polyethylene insert

Song,

Hwang,

Baek

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To investigate the aseptic survival of 1.5-stage exchange arthroplasty for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). Methods Eighty-eight cases of 1.5-stage exchange arthroplasty for PJI without reinfection were retrospectively analysed. The autoclaved femoral component and new polyethylene insert (PE) were implanted using antibiotic mixed cement. The explanted tibial component was not reinserted. The Western Ontario and McMaster Universities Osteoarthritis Index and range of motion were clinically evaluated preoperatively and at the last follow-up (the last time for the implant in situ). Radiographically, hip-knee-ankle angle (HKA) and component positions were measured preoperatively, postoperatively (1 month after the 1.5-stage exchange arthroplasty), and at the last follow-up. The survival rate was analysed using the Kaplan-Meier method, in which failure was deined as reoperation due to aseptic failure. Mean period to failure and failure site were analysed. Factors afecting survival were investigated in terms of demographics and inappropriateness of the postoperative HKA (HKA > 0 ± 3°) and component positions (α angle > 95 ± 3°, β angle > 90 ± 3°, γ angle > 3 ± 3°, and δ angle > 87 ± 3°). Results The spacer in-situ time was 3.7 years (0.2-6.4). The clinical results improved hip-knee-ankle signiicantly at the last follow-up. Radiographically, the average HKA was valgus 0.1° postoperatively. The average α, β, γ, and δ angles of the postoperative component positions were 95.9°, 90.4°, 3.8°, and 86.7°, respectively. The 1-, 2-, and 5-year postoperative survival rates were 90.9%, 86.4%, and 80.6%, respectively. The mean period to failure was 2.0 years (0.2-5.3). There were 18 cases of aseptic loosening (20.8%), occurring on both the femur and tibial sides in 1 knee, and only on the tibial side in 17 knees. Inappropriate coronal position of the PE (β angle > 90 ± 3°) was a signiicant factor afecting survival (odds ratio = 5.491; p = 0.011). ConclusionThe aseptic survival of the 1.5-stage exchange arthroplasty was acceptable when using an autoclaved femoral component and new PE. The appropriate coronal position of the PE helps ensure favourable survival of 1.5-stage exchange arthroplasty.

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