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

Kalore, Niraj V.; Maheshwari, Aditya V.; Sharma, Amit; Cheng, Edward Y.; Gioe, Terence J.

doi:10.1007/s11999-011-2037-1

Cited by 49 publications

(42 citation statements)

References 25 publications

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“…By contrast the studies of Hirakawa [40] and Kalore [45] identified much higher re-infection rates of 25% and 28% respectively. These rates are among the highest of the studies identified by this systematic review.…”

Section: Resultsmentioning

confidence: 75%

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A systematic review of the evidence for single stage and two stage revision of infected knee replacement

Masters

Smith

Foguet

et al. 2013

BMC Musculoskelet Disord

122

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BackgroundPeriprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates.MethodsA systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded.Results63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies.ConclusionsEvidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority.

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Section: Resultsmentioning

confidence: 75%

“…Eight studies of between 50 and 60 patients reported reinfection rates of 4% [52], 7% [32], 8% [33], 12% [59] and [70], 25% [40] and 28% [45]. …”

Section: Resultsmentioning

confidence: 99%

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

Masters

Smith

Foguet

et al. 2013

BMC Musculoskelet Disord

122

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“…Emerging data suggest that 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 [8,10,14,20,23]. By contrast, potential advantages of static spacers include lower cost, ease of implantation, and facilitation of wound immobilization whereby tenuous soft tissues, bone deficiency, and extensor mechanism compromise may be better managed.…”

Section: Introductionmentioning

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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“…Compared to an NFC spacer, the autoclaved original femoral component is cost-effective11); however, we are concerned about reusing an implant designed for single use only19).…”

Section: Discussionmentioning

confidence: 99%

Use of a New Knee Prosthesis as an Articulating Spacer in Two-Stage Revision of Infected Total Knee Arthroplasty

Juul

Fabrin

Poulsen

et al. 2016

Knee Surg Relat Res

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PurposeTo report our experience with two-stage revision using a new femoral component (NFC) spacer (Depuy Synthes) as an articulating spacer.Materials and MethodsIn this retrospective study, we reviewed 22 two-stage revisions that were performed using an NFC spacer in 22 patients suspected of having an infected total knee arthroplasty (TKA) from December 2010 to March 2013. The result was considered successful when eradication of infection was achieved using only one NFC spacer.ResultsThe average time from primary TKA to the first stage procedure was 29.1 months and the average time from the first stage procedure until the final second stage procedure was 12.7 weeks. The average range of motion increased from 82° preoperatively to 104° postoperatively. The American Knee Society Knee score increased from 29.3 points to 66 points. The Function score increased from 29.5 points to 64 points. Four cases were reinfected after two-stage revision. The mean follow-up was 37.6 months.ConclusionsThe new articulating spacer showed promising short-term results both with regard to eradication of infection and functional improvement.

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

Cited by 49 publications

References 25 publications

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

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

Use of a New Knee Prosthesis as an Articulating Spacer in Two-Stage Revision of Infected Total Knee Arthroplasty

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