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Intraoperative Molds to Create an Articulating Spacer for the Infected Knee Arthroplasty

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

Abstract

Background

Chronic infections in TKA have been traditionally treated with a two-stage protocol incorporating a temporary antibiotic-loaded cement spacer. The use of a static as opposed to an articulating spacer is controversial. Some surgeons believe a static spacer results in a higher rate of infection eradication, whereas others believe an articulating spacer provides equivalent rates of infection control with improved function between stages and the potential for better eventual range of motion.

Questions/purposes

We determined the rates of infection control and postoperative function for an articulating all-cement antibiotic spacer fashioned intraoperatively from prefabricated silicone molds.

Methods

We retrospectively reviewed 60 patients with an infected TKA using the same cement-on-cement articulating spacer. A minimum of 4 g antibiotic per package of cement was used when making the spacer. Complications and pre- and postoperative knee flexion, extension, and Knee Society scores were recorded. Bone loss associated with the spacer was determined radiographically and by intraoperative inspection of the bony surfaces at the second stage. Minimum followup was 24 months (mean, 35 months; range, 24–51 months).

Results

Seven patients (12%) became reinfected, four with an organism different from that identified at the index resection arthroplasty. One spacer femoral component broke between stages but did not require any specific treatment. We identified no bone loss between stages and no complications related to the cement-on-cement articulation. The mean pretreatment Knee Society scores of 53 improved to 79. The mean preoperative flexion of 90.6º improved to 101.3º at final followup.

Conclusions

An articulating antibiotic spacer was associated with control of a deep periprosthetic infection in 88% of patients while allowing range of motion between stages.

Level of Evidence

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

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Author information

Authors and Affiliations

  1. Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60612, USA

    Geoffrey S. Van Thiel MD, MBA & Craig J. Della Valle MD

  2. Joint Implant Surgeons, New Albany, OH, USA

    Keith R. Berend MD & Adolph V. Lombardi MD

  3. Hartzband Center for Hip and Knee Replacement, Paramus, NJ, USA

    Gregg R. Klein MD

  4. Illinois Bone and Joint Institute, Chicago, IL, USA

    Alexander C. Gordon MD

Authors
  1. Geoffrey S. Van Thiel MD, MBA
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  2. Keith R. Berend MD
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  3. Gregg R. Klein MD
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  4. Alexander C. Gordon MD
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  5. Adolph V. Lombardi MD
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  6. Craig J. Della Valle MD
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Corresponding author

Correspondence to Craig J. Della Valle MD.

Additional information

One of the authors (KRB) is a consultant for and has received research support and royalties for intellectual property from Biomet, Inc (Warsaw, IN) and is a consultant for Synvasive (Reno, NV) and Salient Surgical (Portsmouth, NH). One of the authors (GRK) is a consultant for Biomet. One of the authors (ACG) is a consultant for Biomet, Wright Medical Technology, Inc (Arlington, TN), DePuy Orthopaedics, Inc (Warsaw, IN), and BrainLab (Westchester, IL). One of the authors (AVL) is a consultant for and has received research support and royalties for intellectual property from Biomet and has received royalties from Innomed (Savannah, GA). One of the authors (CJDV) is a consultant for Biomet, Kinamed (Camarillo, CA), Smith and Nephew Inc (Memphis, TN), Angiotech (Vancouver, BC, Canada), and is on the advisory board for CD Diagnostics (Philadelphia, PA). They have also received research support from Zimmer (Warsaw, IN).

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 this study was not required.

Study data collected at Rush University Medical Center, Chicago, IL; Joint Implant Surgeons, New Albany, OH; and Hartzband Center for Hip and Knee Replacement, Paramus, NJ.

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Van Thiel, G.S., Berend, K.R., Klein, G.R. et al. Intraoperative Molds to Create an Articulating Spacer for the Infected Knee Arthroplasty. Clin Orthop Relat Res 469, 994–1001 (2011). https://doi.org/10.1007/s11999-010-1644-6

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  • DOI: https://doi.org/10.1007/s11999-010-1644-6

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