T Classen1, M von Knoch2, M Wernsmann3, S Landgraeber3, F Löer3, M Jäger3. 1. Orthopaedic Department, University of Duisburg - Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany. Electronic address: timclassen@gmx.de. 2. Orthopaedic Department, Hospital of Bremerhaven, Bremerhaven, Germany. 3. Orthopaedic Department, University of Duisburg - Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany.
Abstract
INTRODUCTION: Deep periprosthetic infection is one of the most serious complications after total knee replacement. The two-stage procedure with implantation of a temporary cement spacer and later re-implantation of a revision total knee prosthesis is an accepted procedural standard. The use of articulating spacers has been proposed to enhance ease of revision and functional results. PATIENTS AND METHODS: Twenty-three patients treated with an articulating spacer were retrospectively studied. All patients had undergone a two-stage surgery. The infected prosthesis was explanted and the femoral component was sterilized and re-implanted. On the tibial side a block of gentamicin-loaded bone cement was produced intraoperatively using specially manufactured templates. Eighteen total knee arthroplasty revisions and 5 arthrodesis were finally performed. RESULTS: A total of three (13%) re-infections occurred 5-20 months after revision total knee arthroplasty in a mean follow-up period of 47 months. Prior to re-implantation, flexion with the articulating spacer ranged between 15 and 100° (mean 68±28°). The average postoperative flexion after re-implantation of total knee replacement was 105±11°. CONCLUSION: The articulating spacer used in this study appears to be as effective as the standard procedures in terms of re-infection risk rate and postoperative range of motion recovery. LEVEL OF EVIDENCE: Level IV.
INTRODUCTION: Deep periprosthetic infection is one of the most serious complications after total knee replacement. The two-stage procedure with implantation of a temporary cement spacer and later re-implantation of a revision total knee prosthesis is an accepted procedural standard. The use of articulating spacers has been proposed to enhance ease of revision and functional results. PATIENTS AND METHODS: Twenty-three patients treated with an articulating spacer were retrospectively studied. All patients had undergone a two-stage surgery. The infected prosthesis was explanted and the femoral component was sterilized and re-implanted. On the tibial side a block of gentamicin-loaded bone cement was produced intraoperatively using specially manufactured templates. Eighteen total knee arthroplasty revisions and 5 arthrodesis were finally performed. RESULTS: A total of three (13%) re-infections occurred 5-20 months after revision total knee arthroplasty in a mean follow-up period of 47 months. Prior to re-implantation, flexion with the articulating spacer ranged between 15 and 100° (mean 68±28°). The average postoperative flexion after re-implantation of total knee replacement was 105±11°. CONCLUSION: The articulating spacer used in this study appears to be as effective as the standard procedures in terms of re-infection risk rate and postoperative range of motion recovery. LEVEL OF EVIDENCE: Level IV.
Authors: Kevin Staats; Florian Sevelda; Alexandra Kaider; Christoph Böhler; Irene K Sigmund; Stephan E Puchner; Reinhard Windhager; Johannes Holinka Journal: Infection Date: 2017-10-24 Impact factor: 3.553