Use of Static or Articulating Spacers for Infection Following Total Knee Arthroplasty

Voleti, Pramod B.; Baldwin, Keith; Lee, Gwo Chin

doi:10.2106/jbjs.l.01461

Cited by 116 publications

(98 citation statements)

References 19 publications

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“…In 2013, Voleti et al [30] presented a systematic review comparing outcomes from the use of static and articulating spacers. They evaluated reinfection rates, ROM after second-stage surgery, functional scores, and wound-related and spacer-related problems.…”

Section: Results Of Static Versus Articulating Spacersmentioning

confidence: 99%

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The use of spacers (static and mobile) in infection knee arthroplasty

Mazzucchelli

Rosso

Marmotti

et al. 2015

Curr Rev Musculoskelet Med

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Revision total knee arthroplasty (TKA) is the treatment of choice in patients with periprosthetic joint infection. It may be performed in either a single stage or two stages. In the latter option, between stages, an antibiotic-loaded spacer may be used to maintain a certain amount of joint stability and mobility after the infected implant is removed, adding an intra-articular concentration of antibiotics. There are two types of antibiotic-loaded cement spacers: static and dynamic. Static spacers basically create a temporary arthrodesis with antibiotic-loaded cement and usually are handmade within the surgical field. Dynamic spacers can be created intraoperatively by using different tools or may be prepackaged by the manufacturer; they allow range of motion between stages. In this article, the authors review the indications, surgical techniques, and results for static and dynamic spacers in two-stage revision TKA.

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Section: Results Of Static Versus Articulating Spacersmentioning

confidence: 99%

“…Considering all the advantages and disadvantages of static spacers, these devices may be indicated in patients with ligamentous instability, insufficient extensor mechanism, and massive bone loss after infected prosthesis removal, or in cases of a compromised overlying soft tissue envelope [30][31][32].…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

The use of spacers (static and mobile) in infection knee arthroplasty

Mazzucchelli

Rosso

Marmotti

et al. 2015

Curr Rev Musculoskelet Med

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“…However, the indications for choosing articulating over static spacers remain unclear. 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].…”

Section: Discussionmentioning

confidence: 99%

“…Gooding et al retrospectively reviewed 115 knees undergoing revision for chronic infection using a prefabricated articulating PROSTALAC spacer (Prosthesis of Antibiotic-Loaded Acrylic Cement; DePuy, Warsaw, IN, USA) and found eradication of infection in 101 (88%) of knees at last followup [9]. As discussed previously, two systematic reviews conducted by Voleti et al and Pivec et al failed to elucidate significant differences in the rate of long-standing infection eradication when comparing articulating and nonarticulating spacers [20,23]. It appears both methods represent reasonable strategies for overall treatment of infection.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Selecting a high‐dose antibiotic‐laden cement knee spacer

Hollyer

Ivanov

Kappagoda³

et al. 2023

Journal Orthopaedic Research

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Prosthetic joint infection [PJI] after total knee arthroplasty (TKA) remains a common and challenging problem for joint replacement surgeons and patients. Once the diagnosis of PJI has been made, patient goals and characteristics as well as the infection timeline dictate treatment. Most commonly, this involves a two‐stage procedure with the removal of all implants, debridement, and placement of a static or dynamic antibiotic spacer. Static spacers are commonly indicated for older, less healthy patients that would benefit from soft tissue rest after initial debridement. Mobile spacers are typically used in younger, healthier patients to improve quality of life and reduce soft‐tissue contractures during antibiotic spacer treatment. Spacers are highly customizable with regard to antibiotic choice, cement variety, and spacer design, each with reported advantages, drawbacks, and indications that will be covered in this article. While no spacer is superior to any other, the modern arthroplasty surgeon must be familiar with the available modalities to optimize treatment for each patient. Here we propose a treatment algorithm to assist surgeons in deciding on treatment for PJI after TKA.

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Use of Static or Articulating Spacers for Infection Following Total Knee Arthroplasty

Cited by 116 publications

References 19 publications

The use of spacers (static and mobile) in infection knee arthroplasty

The use of spacers (static and mobile) in infection knee arthroplasty

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

Selecting a high‐dose antibiotic‐laden cement knee spacer

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