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Is There a Preferred Articulating Spacer Technique for Infected Knee Arthroplasty?: A Preliminary Study

  • Symposium: Papers Presented at the Annual Meetings of The Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Periprosthetic infection in TKA is a devastating and challenging problem for both patients and surgeons. Two-stage exchange arthroplasty with an interval antibiotic spacer reportedly has the highest infection control rate. Studies comparing static spacers with articulating spacers have reported varying ROM after reimplant, which could be due to differences in articulating spacer technique.

Questions/purposes

We therefore determined whether one of three articulating spacer techniques was superior in terms of (1) infection control, (2) final ROM, and (3) cost.

Patients and Methods

We retrospectively reviewed 53 patients with infected TKAs who had two-stage exchange arthroplasty with one of three techniques with articulating spacers: autoclaving an original component (n = 15), a new femoral component (n = 16), and a silicone mold component (n = 22). We compared infection control, ROM, and cost. Minimum followup was 12 months (mean, 39 months; range, 12–105 months).

Results

We found no difference in infection control among the three techniques. Infection control was achieved in 13 of 15 (86.7%) autoclaved original component spacers at mean 73 months (range, 37–105 months), 15 of 16 (93.8%) new femoral component spacers at mean 19 months (range, 12–32 months), and 20 of 22 (90.9%) silicone mold component spacers at mean 32 months (range, 14–56 months). Mean final flexion was 95.7°, 98.3°, and 93.8°, respectively. Direct costs for all implants, molds, cement, and antibiotics were $932, $3589, and $3945, respectively.

Conclusions

We found comparable infection control and ROM for the three techniques. Direct cost was least for the autoclaved original component technique.

Level of Evidence

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

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Acknowledgments

The authors thank Paul Lender (University of Minnesota) and Penny Tatman, MPH (HealthEast Care System, St Paul, MN) for their help with the statistical analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis VAMC Section 112E, 1 Veterans Drive, Minneapolis, MN, 55417, USA

    Niraj V. Kalore MD, Aditya Maheshwari MD, Amit Sharma MD, Edward Cheng MD & Terence J. Gioe MD

  2. Department of Orthopaedic Surgery, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA

    Terence J. Gioe MD

Authors
  1. Niraj V. Kalore MD
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  2. Aditya Maheshwari MD
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  3. Amit Sharma MD
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  4. Edward Cheng MD
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  5. Terence J. Gioe MD
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Corresponding author

Correspondence to Terence J. Gioe MD.

Additional information

This material is partially based on work supported (or supported in part) by the Office of Research and Development, Department of Veterans Affairs. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

In support of their research for or preparation of this work, one or more of the authors (TJG) received funding from DePuy Orthopaedics, Inc (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 the study was obtained.

This work was performed at the University of Minnesota Medical School and the Minneapolis Veterans Affair Medical Center.

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Kalore, N.V., Maheshwari, A., Sharma, A. et al. Is There a Preferred Articulating Spacer Technique for Infected Knee Arthroplasty?: A Preliminary Study. Clin Orthop Relat Res 470, 228–235 (2012). https://doi.org/10.1007/s11999-011-2037-1

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  • DOI: https://doi.org/10.1007/s11999-011-2037-1

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