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Minimizing Dynamic Knee Spacer Complications in Infected Revision Arthroplasty

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

Abstract

Background

Deep infections are devastating complications of TKA often treated with component explantation, intravenous antibiotics, and antibiotic-impregnated cement spacers. Historically, the spacers have been static, which may limit patients’ ROM and ability to walk. Several recent reports describe dynamic spacers, which may allow for improved ROM and make later reimplantation easier. However, because of several dynamic spacer problems noted at our institution, we wanted to assess their associated failures, reinfection rates, and functionality.

Questions/purposes

We therefore asked whether there were differences between static and dynamic spacers in (1) reinfection rates, (2) complications directly related to the spacer, and (3) final patient functionality as measured by Knee Society objective scores and ROM.

Patients and Methods

We retrospectively identified 111 patients (115 knees) with 34 dynamic spacers (30%) and 81 static spacers (70%). Reinfection rates, complications requiring additional surgery, and final Knee Society scores and ROM were collected for all patients.

Results

Reinfection rates were comparable between groups. In the dynamic spacer cohort, there were four complications; however, these could all be explained by surgical technical errors or patient weightbearing compliance. All patients with failed results eventually underwent successful two-stage exchange arthroplasty. Final Knee Society scores and ROM were also similar between groups.

Conclusions

Reinfection rates, Knee Society scores, and ROM were comparable between the static and dynamic spacer groups. Meticulous surgical technique and proper patient selection should be used to avoid any complications with any spacers.

Level of Evidence

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

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Authors and Affiliations

  1. Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Aaron J. Johnson MD, Siraj A. Sayeed MD, Qais Naziri MD, Harpal S. Khanuja MD & Michael A. Mont MD

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  1. Aaron J. Johnson MD
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  2. Siraj A. Sayeed MD
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  3. Qais Naziri MD
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  4. Harpal S. Khanuja MD
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  5. Michael A. Mont MD
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Corresponding author

Correspondence to Michael A. Mont MD.

Additional information

MAM is a consultant for Stryker Orthopaedics (Mahwah, NJ), Wright Medical Technology Inc (Arlington, TN), and Salient Surgical Technologies Inc (Dover, NH) and receives royalties from Stryker Orthopaedics. The remaining authors certify that they have 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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Johnson, A.J., Sayeed, S.A., Naziri, Q. et al. Minimizing Dynamic Knee Spacer Complications in Infected Revision Arthroplasty. Clin Orthop Relat Res 470, 220–227 (2012). https://doi.org/10.1007/s11999-011-2095-4

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  • DOI: https://doi.org/10.1007/s11999-011-2095-4

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