Scott R Nodzo1, Keely K Boyle2, Sara Spiro3, Allina A Nocon4, Andy O Miller5, Geoffrey H Westrich6. 1. Hospital for Special Surgery, Department of Orthopedics, United States. Electronic address: Spodzo@gmail.com. 2. Hospital for Special Surgery, Department of Orthopedics, United States. Electronic address: keelyboyle@gmail.com. 3. Hospital for Special Surgery, Department of Orthopedics, United States. Electronic address: spiros@hss.edu. 4. Hospital for Special Surgery, Complex Joint Reconstruction Center, United States. Electronic address: nocona@hss.edu. 5. Hospital for Special Surgery, Department of Infectious Disease, United States. Electronic address: milleran@hss.edu. 6. Hospital for Special Surgery, Department of Orthopedics, United States. Electronic address: westrichg@hss.edu.
Abstract
BACKGROUND: The optimal type, characteristics, and success rates of articulating antibiotic spacers used during total knee arthroplasty (TKA) periprosthetic joint infection (PJI) have not been well defined in a single series. We sought to (1) determine the success rate for three unique spacer constructs and (2) evaluate any microbiological, surgical, or patient characteristics that would influence the success rate. METHODS: We retrospectively reviewed patients who underwent a two-stage exchange for a TKA PJI with a prefabricated spacer (PREFAB), home-made mold (MOLD), or autoclaved femoral component (AUTOCL). Patient demographics, microbiology data, amount of antibiotic in each spacer construct, postoperative course, and infection cure outcomes were evaluated. RESULTS: The success rate for being infection free at final follow-up without the need for further reoperation for infection was 82.7% in the PREFAB group, 88.4% in the MOLD group, and 79.4% in the AUTOCL group (p=0.54). There was no clear statistical link between raw quantities of vancomycin and aminoglycoside in the spacer and a successful outcome. The surgeon's own intraoperatively created mold group had the lowest construct cost at a mean $1341.00±889.10 (p<0.0001) per construct, while the commercial cement molds had the highest mean cost at $5439.00±657.80 (p<0.0001). CONCLUSIONS: There was no statistically significant difference in the success rates between the antibiotic spacer types. The surgeon's own intraoperative mold had the least overall associated cost.
BACKGROUND: The optimal type, characteristics, and success rates of articulating antibiotic spacers used during total knee arthroplasty (TKA) periprosthetic joint infection (PJI) have not been well defined in a single series. We sought to (1) determine the success rate for three unique spacer constructs and (2) evaluate any microbiological, surgical, or patient characteristics that would influence the success rate. METHODS: We retrospectively reviewed patients who underwent a two-stage exchange for a TKA PJI with a prefabricated spacer (PREFAB), home-made mold (MOLD), or autoclaved femoral component (AUTOCL). Patient demographics, microbiology data, amount of antibiotic in each spacer construct, postoperative course, and infection cure outcomes were evaluated. RESULTS: The success rate for being infection free at final follow-up without the need for further reoperation for infection was 82.7% in the PREFAB group, 88.4% in the MOLD group, and 79.4% in the AUTOCL group (p=0.54). There was no clear statistical link between raw quantities of vancomycin and aminoglycoside in the spacer and a successful outcome. The surgeon's own intraoperatively created mold group had the lowest construct cost at a mean $1341.00±889.10 (p<0.0001) per construct, while the commercial cement molds had the highest mean cost at $5439.00±657.80 (p<0.0001). CONCLUSIONS: There was no statistically significant difference in the success rates between the antibiotic spacer types. The surgeon's own intraoperative mold had the least overall associated cost.
Authors: Gowrishankar Muthukrishnan; Sandeep Soin; Christopher A Beck; Alex Grier; James D Brodell; Charles C Lee; Cheryl L Ackert-Bicknell; Frances Eun-Hyung Lee; Edward M Schwarz; John L Daiss Journal: Immunohorizons Date: 2020-06-22
Authors: Benjamin F Ricciardi; Gowrishankar Muthukrishnan; Elysia Masters; Mark Ninomiya; Charles C Lee; Edward M Schwarz Journal: Curr Rev Musculoskelet Med Date: 2018-09
Authors: Benjamin F Ricciardi; Gowrishankar Muthukrishnan; Elysia A Masters; Nathan Kaplan; John L Daiss; Edward M Schwarz Journal: J Orthop Res Date: 2020-01-31 Impact factor: 3.494