Comparing the Efficacy of Articulating Spacer Constructs for Knee Periprosthetic Joint Infection Eradication: All-Cement vs Real-Component Spacers.

Abstract

BACKGROUND:

The most common treatment for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a 2-stage revision. Few studies have compared different articulating spacer constructs. This study compares the outcomes of real-component and all-cement articulating spacers for TKA PJI treatment.

METHODS:

This retrospective observational study examined the arthroplasty database at 3 academic hospitals for articulating spacers placed for TKA PJIs between April 2011 and August 2020. Patients were categorized as receiving a real-component or an all-cement articulating spacer. Data on demographics, surgical information, and outcomes were collected.

RESULTS:

One-hundred sixty-four spacers were identified: 72 all-cement and 92 real-component spacers. Patients who received real-component spacers were older (67 ± 10 vs 63 ± 12 years; P = .04) and more likely to be former smokers (50.0% vs 28.6%; P = .02). Real-component spacers had greater range of motion (ROM) after Stage 1 (84° ± 28° vs 58° ± 28°; P < .01) and shorter hospital stays after Stage 1 (5.8 ± 4.3 vs 8.4 ± 6.8 days; P < .01). There was no difference in time to reimplantation, change in ROM from pre-Stage 1 to most recent follow-up, or reinfection. Real-component spacers had shorter hospital stays (3.3 ± 1.7 vs 5.4 ± 4.9 days; P < .01) and operative times during Stage 2 (162.2 ± 47.5 vs 188.0 ± 66.0 minutes; P = .01).

CONCLUSION:

Real-component spacers had improved ROM after Stage 1 and lower blood loss, shorter operative time, and shorter hospital stays after Stage 2 compared to all-cement articulating spacers. The 2 spacer constructs had the same ultimate change in ROM and no difference in reinfection rates, indicating that both articulating spacer types may be safe and effective options for 2-stage revision TKA.

LEVEL OF EVIDENCE:

III, retrospective observational analysis.

• Authors: Mackenzie A Roof, Jessica L Baylor, Jenna A Bernstein, Brielle J Antonelli, David N Kugelman, Alexander J Egol, Christopher M Melnic, Antonia F Chen, William J Long, Vinay K Aggarwal, Ran Schwarzkopf
• Journal: The Journal of arthroplasty (J Arthroplasty) Vol. 36 Issue 7S Pg. S320-S327 (07 2021) ISSN: 1532-8406 [Electronic] United States
• PMID: 33579629 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Humans
• Knee Joint
• Knee Prosthesis (adverse effects)
• Prosthesis-Related Infections (drug therapy, epidemiology, surgery)
• Reoperation
• Retrospective Studies
• Treatment Outcome