Two-stage approach to total knee arthroplasty using colistin-loaded articulating cement spacer for vancomycin-resistant Pseudomonas aeruginosa infection in an arthritic knee

Chang, Moon Jong; Song, Min Kyu; Shin, Jae Hoon; Yoon, Chang-Hwan; Chang, Chong Bum; Kang, Sungchul

doi:10.1007/s00590-018-2268-x

Cited by 7 publications

(11 citation statements)

References 18 publications

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“…The addition of an allograft, while it increases overall graft diameter, may have detrimental effects as studies have shown that processed grafts could negatively impact biomechanical properties and patient outcomes [4, 23, 24]. The association between processing techniques for allografts used in HY grafts and outcomes following primary ACLR was outside the scope of the present study comparing < 8 mm HA to ≥ 8 mm HY.…”

Section: Discussionmentioning

confidence: 92%

“…However, prior studies have reported mixed results with some showing HY to have a higher risk of revision or worse functional scores when compared to HA, while others have found better outcomes with a HY or failed to observe a difference in outcomes between the two graft types. A recent meta‐analysis of these studies failed to observe a difference in graft failure and functional scores when comparing HA and hybrid grafts [4]. Unfortunately, these studies have small sample sizes or performed in an older patient population where the incidence of revision is lower and therefore a difference may not be detected.…”

Section: Introductionmentioning

confidence: 99%

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No difference in revision risk between autologous hamstring graft less than 8 mm versus hybrid graft 8 mm or larger in anterior cruciate ligament reconstruction

Mirzayan

Chang

Royse

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeHamstring autograft (HA) is commonly used for primary anterior cruciate ligament reconstruction (ACLR). However, if the harvested HA is inadequate in diameter, it is often augmented with an allograft tendon, forming a hybrid graft (HY). This study sought to evaluate aseptic revision risk following HA versus HY ACLR. MethodsA retrospective cohort study was performed using data obtained from our healthcare system’s ACLR registry. Patients ≤ 25 years of age who underwent primary isolated ACLR were identified (2005–2020). Graft type and diameter size was the primary exposure of interest: < 8 mm HA and ≥ 8 mm HY. A secondary analysis was performed to examine 7 mm HA and 7.5 mm HA vs ≥ 8 mm HY. Propensity score‐weighted Cox proportional hazard regression was used to evaluate the risk of aseptic revision. ResultsThe study sample included 1,945 ACLR: 548 ≥ 8 mm HY, 651 7 mm HA, and 672 7.5 mm HA. The crude cumulative aseptic revision probability at 8‐years for ≥ 8 mm HY was 9.1%, 11.1% for 7 mm HA, and 11.2% for 7.5 mm HA. In adjusted analysis, no difference in revision risk was observed for < 8 mm HA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.72–1.82), 7 mm HA (HR 1.23, 95% CI 0.71–2.11), or 7.5 mm HA (HR 1.16, 95% CI 0.74–1.82) compared to ≥ 8 mm HY. ConclusionIn a US‐based cohort of ACLR patients aged ≤ 25 years, we failed to observe any differences in aseptic revision risk for HA < 8 mm compared to HY ≥ 8 mm. Augmentation of a HA as small as 7 mm is not necessary to prevent a revision surgery. Level of evidenceLevel III.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

No difference in revision risk between autologous hamstring graft less than 8 mm versus hybrid graft 8 mm or larger in anterior cruciate ligament reconstruction

Mirzayan

Chang

Royse

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…Treatment with a static antibiotic spacer and staged knee arthroplasty is effective [10][11][12][13]. The PJI literature has demonstrated articulating spacers to be superior [14,15] and supports using articulating spacers whenever the remaining bone and soft tissue allow.…”

Section: Introductionmentioning

confidence: 99%

Articulating vs Static Spacers for Native Knee Infection in the Setting of Degenerative Joint Disease

et al. 2021

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Background: Patients with advanced knee arthritis who develop a septic joint are not adequately treated with irrigation and debridement and intravenous antibiotics because of antecedent cartilage damage. The gold standard treatment has been a 2-stage approach. The periprosthetic joint infection literature has demonstrated the superiority of articulating spacers, and metal-on-poly (MOP) spacers are being used with increasing frequency. The purpose of this study was to compare the postoperative outcomes of patients with infected, arthritic knees treated by a 2-stage approach to those of patients who received single-stage treatment with a MOP spacer. Methods: Sixteen patients with native knee septic arthritis treated with an antibiotic spacer between 1998 and 2019 were reviewed. Demographic data, clinical data, knee motion, Knee Society score, Timed-Up-and-Go, and pain scores were collected. Survivorship of final implants was compared. Results: Six of 16 knees (38%) received single-stage treatment, and 10 received 2-stage treatment (62%). Five of 6 MOP spacers (83%) were retained at a mean follow-up of 3 ± 1.2 years. Nine of 10 (90%) receiving static spacers had subsequent reconstruction, with 9 (100%) surviving at mean follow-up of 7 ± 3.2 years. The patients who received MOP spacers trended toward greater terminal flexion, higher Knee Society score, and faster Timed-Up-and-Go at final follow-up. Conclusion: Infection in a native, arthritic knee may be effectively treated using single-stage MOP spacer. Postoperative outcomes of single-stage MOP spacers compare favorably to staged static spacers and with those undergoing revision surgery for other indications. Longer follow-up is needed to evaluate durability of MOP spacers.

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“…A few studies have reported a two‐stage approach for the treatment of patients with infection and advanced knee arthritis with TKA implantation in the second stage [8, 13, 21, 27, 28, 30, 40]. An antibiotic cement spacer, as is used in the treatment of chronic infected TKA [24], was used in these patients.…”

Section: Introductionmentioning

confidence: 99%

A two-stage approach to primary TKA using articulating antibiotic-loaded spacers improve function and eradicate infection in septic arthritic knees

Pietsch¹,

Hochegger²,

Djahani³

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose The treatment of an infected arthritic knee might be challenging. The failure rate has been reported to be high for open or arthroscopic debridement. A subsequently high rate of infection has been noted in these patients undergoing primary total knee arthroplasty (TKA). In the present study, a two-stage approach using an articulating spacer was used. The hypothesis was that the procedure would eradicate the infection and improve pain and function in these patients. Methods A total of 16 consecutive patients were enrolled in this retrospective study. The mean follow-up time was 6.1 years (range 2.0-9.9 years). Patients with advanced osteoarthritis and infection of the knee were included. All patients had previously undergone one or more failed arthroscopic or open procedures for the eradication of infection. All patients received the same homemade metal-on-plastic articulating antibiotic spacer. Double antibiotic therapy was given for 2 weeks intravenously and orally for 4 weeks. TKA implantation was performed 6 weeks after the irst stage. ResultsThe infection was eradicated without recurrence in all patients. The functional results were signiicantly improved, and pain was signiicantly reduced after spacer and TKA implantation. The mean amount of knee lexion was 95 ± 30° preoperatively, and it increased to 109 ± 14° (p = 0.012) after spacer implantation and to 119 ± 10° (p = 0.002) after TKA implantation. The mean KSS objective was 58 ± 12 preoperatively, and it increased to 75 ± 14 (p < 0.0001) after spacer implantation and to 96 ± 3 (p < 0.0001) after TKA implantation. The mean KSS function was 17 ± 11 preoperatively, and it increased to 46 ± 10 (p < 0.0001) after spacer implantation and to 86 ± 6 (p < 0.0001) after TKA implantation. The mean VAS score was 65 ± 11 preoperatively, and it decreased to 2 ± 4 (p < 0.0001) after spacer implantation and to 1 ± 2 (p < 0.0001) after TKA implantation. Conclusion The two-stage procedure for the treatment of infected arthritic knees after failed eradication surgery was efective in all patients. Using an antibiotic articulating metal-on-plastic cement spacer showed improved functional results between the stages and at the inal follow-up. No intra-or postoperative complications occurred.

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Two-stage approach to total knee arthroplasty using colistin-loaded articulating cement spacer for vancomycin-resistant Pseudomonas aeruginosa infection in an arthritic knee

Abstract: A two-stage approach to TKA using a colistin-loaded articulating cement spacer can be used for an arthritic knee infected by vancomycin-resistant P. aeruginosa. Furthermore, local administration of colistin using a cement spacer can reduce the systemic side effects of colistin.

Cited by 7 publications

References 18 publications

No difference in revision risk between autologous hamstring graft less than 8 mm versus hybrid graft 8 mm or larger in anterior cruciate ligament reconstruction

No difference in revision risk between autologous hamstring graft less than 8 mm versus hybrid graft 8 mm or larger in anterior cruciate ligament reconstruction

Articulating vs Static Spacers for Native Knee Infection in the Setting of Degenerative Joint Disease

A two-stage approach to primary TKA using articulating antibiotic-loaded spacers improve function and eradicate infection in septic arthritic knees

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