Functional interest of an articulating spacer in two-stage infected total knee arthroplasty revision - 27/05/14

Doi : 10.1016/j.otsr.2014.01.010

T. Classen ^a,^⁎ , M. von Knoch ^b, M. Wernsmann ^a, S. Landgraeber ^a, F. Löer ^a, M. Jäger ^a
^a Orthopaedic Department, University of Duisburg – Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany
^b Orthopaedic Department, Hospital of Bremerhaven, Bremerhaven, Germany

^⁎Corresponding author.

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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.