Posterior-Stabilized Antibiotic Cement Articulating Spacer With Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study

Lin, Tsung-Li; Tsai, Cheng-Han; Fong, Yi‐Chin; Shie, Ming‐You; Chen, Huiyi; Chen, Yi-Wen

doi:10.1016/j.arth.2022.01.094

Cited by 4 publications

(15 citation statements)

References 55 publications

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“…However, posterior subluxation of the knee joint occurred in 1 patient. This complication may have been avoided through meticulous tibial spacer molding, adjustment of the thickness of the tibial spacer, or implementation of a spacer postcam mechanism [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

The Use of a Novel On-bone Femoral Spacer Molding Device for Reducing Femoral Spacer Complications in Periprosthetic Total Knee Infection: Preliminary Results

Chulsomlee,

Warinsiriruk,

Thongchuea

et al. 2024

Arthroplasty Today

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Section: Discussionmentioning

confidence: 99%

The Use of a Novel On-bone Femoral Spacer Molding Device for Reducing Femoral Spacer Complications in Periprosthetic Total Knee Infection: Preliminary Results

Chulsomlee,

Warinsiriruk,

Thongchuea

et al. 2024

Arthroplasty Today

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“…Hypothetical advantages of improved stability may be offset by providing an additional surface for bacterial adherence and biofilm formation. In a retrospective comparative study of posterior-stabilized articulating spacers, Lin et al [ 25 ] reported no spacer subluxations or dislocations in mechanically reinforced spacers compared to those without Kirschner wire-reinforced cams. There have also been techniques described in the hip to improve the mechanical stability of articulating spacers via a hybrid screw-cement fixation technique [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Mechanical Complications of Hip and Knee Spacers Are Common

Costanzo¹,

McCahon²,

Tokarski³

et al. 2023

Cureus

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Introduction Two-stage revision is frequently used for the treatment of periprosthetic joint infection (PJI). Because antibiotic-loaded cement spacers are constructed and implanted as temporary devices, mechanical complications are possible. The purpose of our study was to define the incidence of such mechanical complications, determine associated risk factors, and establish if such complications influence the subsequent success of PJI treatment. Methods We identified patients who received an antibiotic spacer for the treatment of PJI at a single center over a six-year timeframe. Medical records and all radiographs were collected and reviewed. Radiographic changes over time were recorded, and mechanical complications were noted. We used multivariate logistic regression analysis to assess risk factors for mechanical spacer complications and assess whether such complications influence the likelihood of subsequent reimplantation and ultimate component retention. Results A total of 236 patients were included in the study. There were 82 hip spacers (28% dynamic and 72% static) with a mechanical complication rate of 8.5% and 154 knee spacers (44% dynamic and 56% static) with a mechanical complication rate of 18.2%. Knee spacers were significantly more likely to have mechanical complications than hip spacers. Other risk factors for mechanical complications included bone loss and elevated body mass index (BMI). Bone loss and advanced age were found to be independent risk factors for failure to undergo second-stage reimplantation. Mechanical spacer failure was not an independent risk factor for the likelihood of subsequent reimplantation or ultimate component retention. Conclusions Mechanical complications of antibiotic spacers are common but do not appear to negatively impact the likelihood of subsequent reimplantation or component retention. In knee spacers and in patients with bone loss or elevated BMI, appropriate patient counseling and strategies to prevent such complications are recommended.

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“…In other words, there were approximately 100 patients in each cohort. Therefore, high volume was defined as ≥14 RAs/year, and low volume was defined as <14 RAs/year [8].…”

Section: Patientsmentioning

confidence: 99%

“…Despite their advantages, less than half of articulating spacers are considered optimally sized and positioned, and the rates of various mechanical complications, such as spacer fracture or migration, periprosthetic fracture, joint subluxation or dislocation, or extensor mechanism disruption, as high as 57%, have been reported [6]. These mechanical complications may lead to additional spacer exchange, compromised functional outcomes, prolonged treatment course, the need for more constrained prostheses, and decreased survivorship after reimplantation [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…However, the effects of surgeon volume on mechanical complications following resection arthroplasty (RA) using articulating spacers remain unclear. To the best of our knowledge, only one study found that being an LV surgeon is a risk factor associated with dislocation and malalignment/malpositioning of spacers [8]. Understanding the outcomes of HV and LV surgeons is helpful in counseling patients and taking measures to improve the success of two-stage revisions.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Surgeon Volume on Mechanical Complications after Resection Arthroplasty with Articulating Spacer

Ko,

Tsai,

Fong

et al. 2024

JPM

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Two-stage revision with an antibiotic-loaded cement articulating spacer is a standard treatment for chronic prosthetic knee infection (PKI); however, mechanical complications can occur during the spacer period. There is limited evidence on the association between surgeon volume and mechanical complications after resection arthroplasty (RA) using an articulating spacer. This study aimed to compare the rates of mechanical complications and reoperation after RA with articulating spacers by surgeons with high volumes (HV) and low volumes (LV) of RA performed and analyzed the risk factors for mechanical failure. The retrospective study investigated 203 patients treated with PKIs who underwent RA with articulating spacers and were divided according to the number of RAs performed by the surgeons: HV (≥14 RAs/year) or LV (<14 RAs/year). Rates of mechanical complications and reoperations were compared. Risk factors for mechanical complications were analyzed. Of the 203 patients, 105 and 98 were treated by two HV and six LV surgeons, respectively. The mechanical complication rate was lower in HV surgeons (3.8%) than in LV surgeons (36.7%) (p < 0.001). The reoperation rate for mechanical complications was lower in HV surgeons (0.9%) than in LV surgeons (24.5%) (p < 0.001). Additionally, 47.2% of patients required hinge knees after mechanical spacer failure. Medial proximal tibial angle < 87°, recurvatum angle > 5°, and the use of a tibial spacer without a cement stem extension were risk factors for mechanical complications. Based on these findings, we made the following three conclusions: (1) HV surgeons had a lower rate of mechanical complications and reoperation than LV surgeons; (2) mechanical complications increased the level of constraint in final revision knee arthroplasty; and (3) all surgeons should avoid tibial spacer varus malalignment and recurvatum deformity and always use a cement stem extension with a tibial spacer.

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Posterior-Stabilized Antibiotic Cement Articulating Spacer With Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study

Cited by 4 publications

References 55 publications

The Use of a Novel On-bone Femoral Spacer Molding Device for Reducing Femoral Spacer Complications in Periprosthetic Total Knee Infection: Preliminary Results

The Use of a Novel On-bone Femoral Spacer Molding Device for Reducing Femoral Spacer Complications in Periprosthetic Total Knee Infection: Preliminary Results

Mechanical Complications of Hip and Knee Spacers Are Common

Effect of Surgeon Volume on Mechanical Complications after Resection Arthroplasty with Articulating Spacer

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