The PROSTALAC functional spacer in two-stage revision for infected knee replacements

Haddad, Fares S.; Masri, Bassam A.; Campbell, David G.; McGraw, Robert W.; Beauchamp, C.P.; Duncan, Clivе P.

doi:10.1302/0301-620x.82b6.0820807

Cited by 133 publications

(94 citation statements)

References 38 publications

(36 reference statements)

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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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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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“…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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“…Spacers also reduce the need for extensile exposures at reimplantation and facilitate patient comfort and early hospital discharge (Calton et al 1997, Haddad et al 2000.…”

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confidence: 99%

Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: Good outcome in 30 patients

Villanueva‐Martínez

Rıos-Luna²,

Pereiro

et al. 2008

Acta Orthopaedica

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Background and purpose The most reliable results when treating an infected total knee arthroplasty have been obtained with a two-stage reimplantation protocol. We have used a simple technique for hand-made spacers and now report the outcome.Patients and methods 30 patients with an infected total knee arthroplasty (TKA) were treated with a 2-stage reimplantation protocol. Spacers were built and customized to the type of defect using only 2 retractors and a high-speed tip burr. Partial weight bearing and discharge from the hospital were encouraged in the time between surgeries. 29 of 30 patients (97%) had successful reimplantations and they were followed for an average of 3 (2-5) years.Results Range of motion with the articulating spacer averaged 80° (55-100) and 21 of the 30 patients achieved motion greater than 75°. At the latest follow-up, there were no reinfections. According to the Knee Society score (KSS), the results were considered excellent or good in 25 patients, and fair or poor in 4 of the 29 patients with reimplantations. Motion after reimplantation averaged 107° (90-120).Interpretation One of the key factors related to a successful outcome with a two-stage reimplantation procedure is to keep the joint mobile and functional in the time between surgeries. Hand-made articulating spacers retain most of the advantages of more complex spacers in terms of mobility, pain, bone loss, success, or re-infection rate-with the major advantages of price and universal availability. Limitations related to this technique

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The PROSTALAC functional spacer in two-stage revision for infected knee replacements

Cited by 133 publications

References 38 publications

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

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

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

Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: Good outcome in 30 patients

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