JOURNAL ARTICLE

Intraoperative molds to create an articulating spacer for the infected knee arthroplasty

Geoffrey S Van Thiel, Keith R Berend, Gregg R Klein, Alexander C Gordon, Adolph V Lombardi, Craig J Della Valle
Clinical Orthopaedics and related Research 2011, 469 (4): 994-1001
21042896

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.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read
21042896
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"