Skip to main content
SpringerLink
Log in

Functional outcome of two-stage reimplantation in patients with periprosthetic joint infection after primary total knee arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Introduction

Two-stage reimplantation in patients with chronic periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) with the use of either articulating or static antibiotic-loaded spacers during the first step is considered to be the golden standard in orthopaedics.

The aim of the study

The aim of the study was to evaluate the correlation of spacer type with the infection elimination rate as well as functional outcomes after two-staged revision TKA in patients with PJI.

Materials and methods

The cohort comprised 161 patients who were treated for PJI after TKA during a period from January 2007 to December 2015. After the exclusion of patients with severe bone defects (AORI 2B or 3), 104 were left for the analysis: 72 patients with articulating and 32 with static spacers. The overall patient mean age was 62 years old (95% CI, 30–84): 73 for females, 31 for males. The outcomes were evaluated after three, six and 12 months using the American Knee Society Score (KSS) and EQ-5D. Only 92 patients were available for observation: 25 with static and 67 with articulating spacers.

Results

One year after the surgery, patients with articulating spacers demonstrated significantly higher mean KSS and function scores in comparison to patients with static spacers (90.4, 77.3 and 78.5, 67.8, respectively (p < 0.05)). The range of motion was also significantly better in patients with articulating spacers: 104.9° in comparison to 93.9° (р < 0.0001). The final EQ-5D score was comparable in both groups (0.82, 73.1 in articulating and 0.82, 72.6 in static spacers).

Conclusion

The two-stage revision TKA for PJI using articulating spacers in comparison to the static ones provides better infection eradication rate as well as functional outcomes and improved quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Boelch SP, Jakuscheit A (2018) Periprosthetic infection is the major indication for TKA revision -experiences from a university referral arthroplasty center. BMC Musculoskelet Disord 19(1):395

    Article  CAS  Google Scholar 

  2. Koh, I.J. and W.S. Cho (2014) Kleos Korea Research Group. Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study. Clin Orthop Relat Res, 472(1): p. 316–326

    Article  Google Scholar 

  3. Koh CK, Zeng I (2017) Periprosthetic joint infection is the main cause of failure for modern knee arthroplasty: an analysis of 11,134 knees. Clin Orthop Relat Res 475(9):2194–2201

    Article  Google Scholar 

  4. Sharkey, P.F. and W.J. Hozack (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res, (404): p. 7–13

    Article  Google Scholar 

  5. Le DH, Goodman SB (2014) Current modes of failure in TKA: infection, instability, and stiffness predominate. Clin Orthop Relat Res 472(7):2197–2200

    Article  Google Scholar 

  6. Parvizi J, Gehrke T (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95-B(11):1450–1452

    Article  CAS  Google Scholar 

  7. Yuan J, Yan Y (2017) Diagnostic accuracy of alpha-defensin in periprosthetic joint infection: a systematic review and meta-analysis. Int Orthop 41(12):2447–2455

    Article  Google Scholar 

  8. Bozhkova, S.A, (2011) Modern principles of diagnostics and antibacterial therapy of prosthetic joint infection (review). Traumatology and Orthopedics of Russia, (3): p. 126-136. (In Russ.)

  9. Bengtson S, Knutson K (1991) The infected knee arthroplasty. A 6-year follow-up of 357 cases. Acta Orthop Scand 62(4):301–311

    Article  CAS  Google Scholar 

  10. Brandt CM, Sistrunk WW (1997) Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis 24(5):914–919

    Article  CAS  Google Scholar 

  11. Buechel FF, Femino FP (2004) Primary exchange revision arthroplasty for infected total knee replacement: a long-term study. Am J Orthop (Belle Mead NJ) 33(4):190–198

    Google Scholar 

  12. Castelli CC, Gotti V (2014) Two-stage treatment of infected total knee arthroplasty: two to thirteen year experience using an articulating preformed spacer. Int Orthop 38(2):405–412

    Article  Google Scholar 

  13. Lichstein P, Su S (2016) Treatment of Periprosthetic knee infection with a two-stage protocol using static spacers. Clin Orthop Relat Res 474(1):120–125

    Article  Google Scholar 

  14. Chen YP, Wu CC (2016) Autoclaved metal-on-cement spacer versus static spacer in two-stage revision in periprosthetic knee infection. Indian Journal of Orthopaedics 50(2):146–153

    Article  Google Scholar 

  15. Emerson RH Jr, Muncie M (2002) Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res 404:132–138

    Article  Google Scholar 

  16. Haddad FS, Masri BA (2000) The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br 82(6):807–812

    Article  CAS  Google Scholar 

  17. Insall JN, Dorr LD (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res (248):13–14

  18. Silvestre A, Almeida F (2013) Revision of infected total knee arthroplasty: two-stage reimplantation using an antibiotic-impregnated static spacer. Clin Orthop Surg 5(3):180–187

    Article  Google Scholar 

  19. Vasso M, Del Regno C (2016) Articulated spacer provides long-term knee improvement after two-stage reimplantation. Knee Surg Sports Traumatol Arthrosc 24(10):3100–3105

    Article  Google Scholar 

  20. Parvizi J, Azzam K (2009) Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res 467(7):1732–1739

    Article  Google Scholar 

  21. Barjaktarović R, Radoičić D (2014) Antibiotic-loaded cement spacer for treatment of Klebsiella infected total hip and knee arthroplasty. Vojnosanit Pregl 71(10):957–962

    Article  Google Scholar 

  22. Akgün D, Perka C (2018) Outcome of hip and knee periprosthetic joint infections caused by pathogens resistant to biofilm-active antibiotics: results from a prospective cohort study. Arch Orthop Trauma Surg 138(5):635–642

    Article  Google Scholar 

  23. Triantafyllopoulos GK, Memtsoudis SG (2017) Periprosthetic infection recurrence after 2-stage exchange arthroplasty: failure or fate? J Arthroplast 32(2):526–531

    Article  Google Scholar 

  24. Haddad FS, Sukeik M (2015) Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections? Clin Orthop Relat Res 473(1):8–14

    Article  Google Scholar 

  25. Fehring TK, Odum S (2000) Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award Clin Orthop Relat Res 380:9–16

    Article  Google Scholar 

  26. Park SJ, Song EK (2010) Comparison of static and mobile antibiotic-impregnated cement spacers for the treatment of infected total knee arthroplasty. Int Orthop 34(8):1181–1186

    Article  Google Scholar 

  27. Shaikh AA, Ha CW (2014) Two-stage approach to primary TKA in infected arthritic knees using intraoperatively molded articulating cement spacers. Clin Orthop Relat Res 472(7):2201–2207

    Article  Google Scholar 

  28. Janssen M.F. and A.S. Pickard (2013). Qual Life Res, Sep;22(7):1717–1727

Download references

Author information

Authors and Affiliations

  1. Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden, Akademika Baykova St., 8, St. Petersburg, 195427, Russian Federation

    Petr Mikhailovich Preobrazhensky, Svetlana Anatolievna Bozhkova, Alexander Viktorovich Kazemirsky, Rashid Murtazalievich Tikhilov, Taras Andreevich Kulaba & Nikolai Nikolaevich Kornilov

Authors
  1. Petr Mikhailovich Preobrazhensky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Svetlana Anatolievna Bozhkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander Viktorovich Kazemirsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rashid Murtazalievich Tikhilov
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Taras Andreevich Kulaba
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nikolai Nikolaevich Kornilov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Petr Mikhailovich Preobrazhensky.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Preobrazhensky, P.M., Bozhkova, S.A., Kazemirsky, A.V. et al. Functional outcome of two-stage reimplantation in patients with periprosthetic joint infection after primary total knee arthroplasty. International Orthopaedics (SICOT) 43, 2503–2509 (2019). https://doi.org/10.1007/s00264-019-04296-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-019-04296-z

Keywords

Search

Navigation