Custom-made Articulating Spacer in Two-stage Revision Total Knee Arthroplasty. An Early Follow-up of 14 Cases of at Least 1 Year after Surgery

Abstract

Total knee replacement (TKR) infection represents only a small percentage of all the potential complications in joint replacement, but one that can lead to disastrous consequences. Two-stage revision, which has been proven to be the most effective technique in eradicating infection, includes prosthesis removal, positioning of an antibiotic-loaded spacer, and systemic antimicrobial therapy for at least 6 weeks. It has been suggested that there is better performance in terms of range of motion, pain, extensor mechanism shortening, and spacer-related bone loss if articulating spacers are used instead of fixed spacers. In this paper, we describe our results in two-stage revision of infected total knee arthroplasty with a minimum follow-up of 12 months on 14 patients treated by antibiotic-loaded custommade articulating spacer as described by Villanueva et al. (Acta Orthop 77(2):329-332, 2006). The mean flexion achieved after the second stage of the revision was 120-, ranging from 97-to 130-. The mean Hospital for Special Surgery score was 84. At 1 year after surgery, none of the knees showed any evidence of recurrence of the infection. Articulating spacers are a suitable alternative to fixed spacers with good range of motion after reimplantation and effectiveness against total knee replacement deep infections.

Loading capacity of dynamic knee spacers: a comparison between hand-moulded and COPAL spacers

“…Savings from an earlier discharge from hospital can outweigh the increased cost of the use of the moulding system [17]. So far, hand-moulded knee spacers have similar advantages to commercially available dynamic spacers with respect to mobility, pain, bone loss, and reinfection rate [28, 50, 53, 56]. In this study, we have also demonstrated that the loading capacity between COPAL and hand-moulded knee spacers were not statistically different.…”

Use of Articulating Spacer Technique in Revision Total Knee Arthroplasty Complicated by Sepsis: A Systematic Meta-Analysis

“…Range of Motion. Preoperative range of motion was reported in 16 studies (numbers 5, 7, 10, 11,12,13,14,17,19,25,27,29,30,32,33, and 34) ( Table 3). The studies' mean±SD for preoperative range of motion for each spacer type were as follows: 74.5°±7.8° for COCH (studies 7, 12, and 30), 77.8°±9.6° for COCM (studies 5, 10, 13, 14, and 25), 58.7°±0.6° for COCP (studies 11, 17, and 33), and 80.3°±4.6° for MOP (studies 19, 27, 29, 32, and 34).…”

Unsatisfactory Outcome of Arthrodesis Performed After Septic Failure of Revision Total Knee Arthroplasty

“…Standard procedures include one-stage or two-stage revision arthroplasty [7][8][9][10] . Most authors prefer a two-stage revision arthroplasty with the placement of a static or mobile cement spacer [8][9][10][11][12][13] . Despite surgical debridement and systemic antibiotic therapy, the recent literature has shown reinfection rates of 15% to 24% following revision surgery for periprosthetic infection, which is possibly due to the shift in the pathogen spectrum to multiresistant bacteria such as methicillin-resistant Staphylococcus aureus or epidermidis or vancomycin-resistant enterococci [11][12][13][14][15][16][17] .…”

“…Most authors prefer a two-stage revision arthroplasty with the placement of a static or mobile cement spacer [8][9][10][11][12][13] . Despite surgical debridement and systemic antibiotic therapy, the recent literature has shown reinfection rates of 15% to 24% following revision surgery for periprosthetic infection, which is possibly due to the shift in the pathogen spectrum to multiresistant bacteria such as methicillin-resistant Staphylococcus aureus or epidermidis or vancomycin-resistant enterococci [11][12][13][14][15][16][17] . If the infection is not eradicated after a one-stage or twostage revision total knee arthroplasty, permanent suppression therapy with antibiotics, amputation, or arthrodesis are treatment Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work.…”