Spacers

Citak, Mustafa; Argenson, Jean-Noël; Masri, B A; Kendoff, Daniel; Springer, Bryan D.; Alt, Volker; Baldini, Andrea; Cui, Quanjun; Deirmengian, Gregory K.; Sel, Hernán Del; Harrer, Michael F.; Israelite, Craig L.; Jahoda, D; Jutte, Paul C.; Levicoff, Eric A.; Meani, E.; Motta, Fernando; Pena, Orestes Ronaldo; Ranawat, Amar S.; Safir, Oleg; Squire, Matthew W.; Taunton, Michael J.; Vogely, Charles; Wellman, Samuel S.

doi:10.1016/j.arth.2013.09.042

Cited by 26 publications

(25 citation statements)

References 112 publications

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“…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]. Proponents of static spacers argue the low cost, ease of implantation, and facilitation of wound immobilization whereby tenuous soft tissues, bone deficiency, and extensor mechanism compromise may be addressed [7].…”

Section: Discussionmentioning

confidence: 99%

“…The consensus indicated 89% agreement that ''…articulating spacers provide better function than non-articulating spacers for the patient in between the stages of TKA. An articulating spacer is especially preferred for the patient who is likely to have a spacer in place for more than 3 months'' [5]. However, at minimum of 2 years followup there was ''…a non-significant trend in ROM improvement with articulating versus non-articulating spacers'' (82% agreement) [5].…”

Section: Discussionmentioning

confidence: 99%

“…Using the Delphi method, over 400 delegates from 52 countries critically assessed the available scientific data to create recommendations and guide therapeutic regimens. Using the available data, the consensus results indicated a ''…non-significant trend in ROM improvement with articulating versus non-articulating spacers'' at minimum 2 years followup (82% agreement) and ''…the type of spacer does not influence the rate of infection eradication with the use of articulating or non-articulating spacers in the knee'' (89% agreement) [5]. It appears imperative that further investigation into restoration of functional ROM and effective eradication of infection in two-stage exchange arthroplasty for PJI be undertaken to further delineate the most efficient means of treatment.…”

Section: Introductionmentioning

confidence: 99%

“…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. By contrast, because restoration of ROM is one of the most critical factors associated with patient satisfaction [18], those in favor of articulating spacers tout the theoretical advantages of easier surgical approaches at the time of reimplantation and superior postreimplantation ROM [5]. In any case, the supposed benefits of using an articulating spacer remain unsubstantiated by available studies beyond 2-year followup [5].…”

Section: Introductionmentioning

confidence: 99%

“…By contrast, because restoration of ROM is one of the most critical factors associated with patient satisfaction [18], those in favor of articulating spacers tout the theoretical advantages of easier surgical approaches at the time of reimplantation and superior postreimplantation ROM [5]. In any case, the supposed benefits of using an articulating spacer remain unsubstantiated by available studies beyond 2-year followup [5]. The recent 2013 Musculoskeletal Infection Society (MSIS) international consensus meeting on PJI endeavored to address these issues.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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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