Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty

Chiang, En-Rung; Su, Yu‐Ping; Chen, Tain-Hsiung; Chiu, Fang-Yao; Chen, Wei-Ming

doi:10.3109/17453674.2011.581266

Cited by 67 publications

(55 citation statements)

References 25 publications

(42 reference statements)

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“…However, the indications for choosing articulating over static spacers remain unclear. In recent reports, it appears articulating spacers offer comparable rates of infection eradication, improved postoperative flexion, and easier surgical exposure when compared with static spacers, albeit at a higher cost and complexity [3,15,20,23], and it has been noted that restoration of ROM is one of the most critical factors associated with patient satisfaction [18]. Importantly, however, some of the supposed benefits of articulating spacers remain unsubstantiated by the available literature at 2-year and greater followup [5].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Lichstein

Hedlund

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Two-stage exchange arthroplasty is a standard approach for treating total knee arthroplasty periprosthetic joint infection in the United States, but whether this should be performed with a static antibiotic spacer or an articulating one that allows range of motion before reimplantation remains controversial. It is unclear if the advantages of articulating spacers (easier surgical exposure during reimplantation and improved postoperative flexion) outweigh the disadvantages of increased cost and complexity in the setting of similar rates of infection eradication. Questions/purposes The purposes of this study were (1) to determine the ultimate range of motion; and (2) to determine the proportion of patients who remained free of infection at a minimum 2 years after treatment with static antibiotic spacers as part of a two-stage revision TKA for the treatment of periprosthetic joint infection. Methods Between 1999 and 2011, we treated 121 patients with chronically infected TKAs, of whom three had medical comorbidities precluding a two-stage exchange, four had died before 2-year followup for reasons other than the surgical intervention, and seven were lost to followup. The remaining 107 patients (109 knees; 53 men and 54 women) were treated using a two-stage approach with static spacers and are evaluated here at a mean of 3.7 years (range, 2.0-9.8 years); no patients were treated with articulating spacers during this study period. Twenty-five percent (27 of 109) of the organisms isolated the first-stage procedure were resistant to methicillin and/or vancomycin. Median age at the time of reimplantation was 67 years (range, 42-89 years). Range of motion was measured by an independent physical therapist with a standard goniometer. Knee Society knee and function scores were calculated before the first stage and at the 2-year mark. Because many of these patients were treated before consensus definitions Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at Stanford University Medical Center, Stanford, CA, USA. of infection were established, we made ...

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Section: Discussionmentioning

confidence: 99%

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Lichstein

Hedlund

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The a priori power analysis was based on the question whether a TTO or QS would result in a superior KSS [53] of at least 20 points in two-stage RTKAs for prosthetic knee infections. Two-stage RTKAs for prosthetic knee infections have reported rates of infection control between 80% and 96% [17,39,42,45,46,50,64,68,84,100]. If a mean reinfection rate is 10% and a difference of 5% would be clinically meaningful, 450 patients per group would reach a power of at least 80% with a CI of 95%.…”

Section: Discussionmentioning

confidence: 99%

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Bruni

Iacono

Sharma

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate. Questions/purposes We compared The Knee Society Score Ó (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation. Methods We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8-15 years). Results Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113°v ersus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups. Conclusions We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections.

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“…Although oral tablets are used for 10 -14 d for skin and soft structure infections, it has also been used safely for months to years for treating chronic bone and joint infections. In these cases, fusidic acid is often combined with rifampin (Drancourt et al 1997;Zimmerli et al 2004;Trampuz and Widmer 2006;Aboltins et al 2007;Ferry et al 2010;Chiang et al 2011). In Europe, the current dosing regimen is 500 mg administered three times a day, orally, which delivers high plasma concentration after a few days, but low plasma levels after the first dose.…”

Section: Pharmacokinetic and Pharmacodynamic Approach To Modified Dosmentioning

confidence: 99%

Fusidic Acid: A Bacterial Elongation Factor Inhibitor for the Oral Treatment of Acute and Chronic Staphylococcal Infections

Fernandes

2016

Cold Spring Harb Perspect Med

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Fusidic acid is an oral antistaphylococcal antibiotic that has been used in Europe for more than 40 years to treat skin infections as well as chronic bone and joint infections. It is a steroidal antibiotic and the only marketed member of the fusidane class. Fusidic acid inhibits protein synthesis by binding EF-G-GDP, which results in the inhibition of both peptide translocation and ribosome disassembly. It has a novel structure and novel mode of action and, therefore, there is little cross-resistance with other known antibiotics. Many mutations can occur in the FusA gene that codes for EF-G, and some of these mutations can result in high-level resistance (minimum inhibitory concentration [MIC] . 64 mg/L), whereas others result in biologically unfit staphylococci that require compensatory mutations to survive. Low-level resistance (,8 mg/L) is more common and is mediated by fusB, fusC, and fusD genes that code for small proteins that protect EF-G-GDP from binding fusidic acid. The genes for these proteins are spread by plasmids and can be selected mostly by topical antibiotic use. Reports of resistance have led to combination use of fusidic acid with rifampin, which is superseded by the development of a new dosing regimen for fusidic acid that can be used in monotherapy. It consists of a front-loading dose to decrease the potential for resistance development followed by a maintenance dose. This dosing regimen is now being used in clinical trials in the United States for skin and refractory bone and joint infections.

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Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty

Cited by 67 publications

References 25 publications

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Fusidic Acid: A Bacterial Elongation Factor Inhibitor for the Oral Treatment of Acute and Chronic Staphylococcal Infections

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