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Durable Infection Control and Function With the PROSTALAC Spacer in Two-stage Revision for Infected Knee Arthroplasty

  • Symposium: Periprosthetic Joint Infection
  • Published:
Clinical Orthopaedics and Related Research®

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Abstract

Background

A two-stage revision total knee arthroplasty is recognized as the gold standard in the treatment of infection. However, traditional spacers limit function in the interval between the two stages and may cause instability, scarring, and bone erosion. The PROSTALAC knee spacer is an antibiotic-loaded cement articulating spacer that allows some movement of the knee between stages. Whether motion enhances long-term function is unknown.

Questions/purposes

We therefore identify the rate of control of infection using the PROSTALAC exchange spacer and to assess the clinical outcome after implantation with a definitive implant.

Methods

We retrospectively reviewed 115 knees that underwent two-stage exchange with the PROSTALAC spacer. Forty-eight of these had a minimum followup of 5 years (mean, 9 years; range, 5–12 years).

Results

At last review, 101 of the 115 knees (88%) had no evidence of infection. Of the 14 knees that became reinfected, four were from the same organism and 10 were with a different organism. After further intervention, using the two-stage approach again, the infection was controlled in 12 of the 14 initially reinfected cases, resulting in a failure to cure in only two cases. We observed improvements in mean WOMAC, Oxford, UCLA, and Patient Satisfaction scores at last review.

Conclusions

The PROSTALAC functional spacer was associated with a 98% rate of control of infection and improvements in the quality-of-life outcomes in the treatment of chronically infected total knee arthroplasties.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Daphne Savoy, research coordinator, without whose valuable help this article would not have been possible, and Eric Sayre for performing the statistical analysis.

Author information

Authors and Affiliations

  1. Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Christopher R. Gooding BSc, MD, FRCS (Tr & Orth), Clive P. Duncan MD, MSc, FRCSC, Nelson V. Greidanus MD, MPH, FRCSC & Donald S. Garbuz MD, MHSc, FRCSC

  2. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Bassam A. Masri MD, FRCSC

  3. Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre, University of British Columbia, 910 West 10th Avenue, 3rd Floor, Vancouver, BC, V5Z 4E1, Canada

    Bassam A. Masri MD, FRCSC

Authors
  1. Christopher R. Gooding BSc, MD, FRCS (Tr & Orth)
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  2. Bassam A. Masri MD, FRCSC
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  3. Clive P. Duncan MD, MSc, FRCSC
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  4. Nelson V. Greidanus MD, MPH, FRCSC
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  5. Donald S. Garbuz MD, MHSc, FRCSC
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Corresponding author

Correspondence to Bassam A. Masri MD, FRCSC.

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Each author certifies that he or she has no 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.

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.

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Gooding, C.R., Masri, B.A., Duncan, C.P. et al. Durable Infection Control and Function With the PROSTALAC Spacer in Two-stage Revision for Infected Knee Arthroplasty. Clin Orthop Relat Res 469, 985–993 (2011). https://doi.org/10.1007/s11999-010-1579-y

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  • DOI: https://doi.org/10.1007/s11999-010-1579-y

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