Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected total knee arthroplasty

Durbhakula, Sridhar M.; Czajka, John; Fuchs, Marc D.; Uhl, Richard L.

doi:10.1016/j.arth.2004.02.036

Cited by 165 publications

(86 citation statements)

References 15 publications

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“…This was comparable to ranges in the literature from 83% to 95% [5,6,14,15,[18][19][20]22]. In one of the few long-term followup studies, Sanchez-Sotelo et al [19] performed a retrospective review of 169 patients undergoing two-stage revision THA for infection and investigated the rates of both mechanical failure and reinfection.…”

Section: Discussionsupporting

confidence: 78%

“…There were some limitations to our study. First, the sample size was limited to 33 patients; however, given the relative infrequency of infections, our sample size was consistent with other reported figures in the literature [5,6,18]. Second, our followup was limited to a minimum of 24 months as a result of the participating centers having adopted this particular prosthesis only in recent years.…”

Section: Discussionmentioning

confidence: 77%

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Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Degen

Davey

Howard

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Introduction Treating deep infection following THA has been a challenge. While the standard treatment has remained a two-stage revision, spacer designs, incorporated antibiotics, and concentrations have varied. Since control of infection may relate to choice and concentration of antibiotics, it is important to report rates of control from various spacers. Questions/purposes We therefore determined (1) the rate of infection control and (2) complications associated with a prefabricated, load-bearing, gentamicinimpregnated hip spacer in treating periprosthetic infections of the hip. Methods We retrospectively reviewed 33 patients with periprosthetic THA infections treated with a prefabricated, partial load-bearing, gentamicin-impregnated hemiarthroplasty spacer. Thirty of the 33 patients underwent second stage reimplantation after a mean 15 weeks. We collected patient demographic data, laboratory values, infecting organism, size of spacer mold, antibiotic selection, complications, and infection control rates from two academic centers. Recurrent infection at last followup was determined by the presence of physical symptoms or signs or elevated serologic tests. The minimum followup was 24 months (mean, 43 months; range, 24-70 months).

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 77%

Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Degen

Davey

Howard

et al. 2012

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…Given the failure to find a difference in infection control between AOC and NFC techniques and the lower cost of the former, we would still recommend use of the AOC technique where permitted. Cement-on-cement articulating spacers can be prepared intraoperatively using silicone molds or can be hand-made or prefabricated [6,9,11,12,20,27]. They have the advantage of greater surface area for antibiotic elution but are available in limited sizes and have the risk of a cement component fracture and cement debris.…”

Section: Discussionmentioning

confidence: 99%

“…Cement-on-cement articulating spacers can also be used. These were initially hand-made [24], but subsequently silicone molds for intraoperatively fabricating cement components (silicon mold components [SMCs]) have been developed [9,23]. Prefabricated cement spacers are also commercially available [27].…”

Section: Introductionmentioning

confidence: 99%

Is There a Preferred Articulating Spacer Technique for Infected Knee Arthroplasty?: A Preliminary Study

Kalore

Maheshwari

Sharma

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Periprosthetic infection in TKA is a devastating and challenging problem for both patients and surgeons. Two-stage exchange arthroplasty with an interval antibiotic spacer reportedly has the highest infection control rate. Studies comparing static spacers with articulating spacers have reported varying ROM after reimplant, which could be due to differences in articulating spacer technique. Questions/purposes We therefore determined whether one of three articulating spacer techniques was superior in terms of (1)

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“…Most modifications have yielded good results (Insall et al 1983, Cohen et al 1988, Booth and Lotke 1989, Duncan et al 1992, McPherson et al 1995, Siebel et al 2002, Durbhakula et al 2004, Ha 2006, Mcavoy and Ries 2006. The simplest, cheapest, and universally available method for making articulating spacers is to build them during surgery (Villanueva et al 2006).…”

mentioning

confidence: 99%

Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: Good outcome in 30 patients

Villanueva‐Martínez

Rıos-Luna²,

Pereiro

et al. 2008

Acta Orthopaedica

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Background and purpose The most reliable results when treating an infected total knee arthroplasty have been obtained with a two-stage reimplantation protocol. We have used a simple technique for hand-made spacers and now report the outcome.Patients and methods 30 patients with an infected total knee arthroplasty (TKA) were treated with a 2-stage reimplantation protocol. Spacers were built and customized to the type of defect using only 2 retractors and a high-speed tip burr. Partial weight bearing and discharge from the hospital were encouraged in the time between surgeries. 29 of 30 patients (97%) had successful reimplantations and they were followed for an average of 3 (2-5) years.Results Range of motion with the articulating spacer averaged 80° (55-100) and 21 of the 30 patients achieved motion greater than 75°. At the latest follow-up, there were no reinfections. According to the Knee Society score (KSS), the results were considered excellent or good in 25 patients, and fair or poor in 4 of the 29 patients with reimplantations. Motion after reimplantation averaged 107° (90-120).Interpretation One of the key factors related to a successful outcome with a two-stage reimplantation procedure is to keep the joint mobile and functional in the time between surgeries. Hand-made articulating spacers retain most of the advantages of more complex spacers in terms of mobility, pain, bone loss, success, or re-infection rate-with the major advantages of price and universal availability. Limitations related to this technique

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Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected total knee arthroplasty

Cited by 165 publications

References 15 publications

Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Is There a Preferred Articulating Spacer Technique for Infected Knee Arthroplasty?: A Preliminary Study

Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: Good outcome in 30 patients

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