Static cement spacers in total knee infection. Custom manufacturing technique and postoperative motion
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Published:
Jun 11, 2015
Keywords:
Deep infection, Total knee arthroplasty, Revision, Static spacer, Articulated spacer, Cement with antibiotic
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Abstract
BackgroundDespite improvements in surgical technique, the number of infections after total knee arthroplasty continues to rise. According to bibliographic reviews, the two-stage exchange procedure has obtained higher percentages of cure than that performed in a single stage. The purpose of this paper was to show our technique for preparing the static spacer, the results and the range of motion achieved with two-stage revision of infected total knee arthroplasty using those spacers. Espaciadores estáticos de cemento con antibiótico en la infección protésica de rodilla Técnica de elaboración y movilidad posoperatoria MethodsWe performed 153 total knee arthroplasty revisions between 1997 and 2010, 33 (21%) of them due to a prosthetic chronic infection, treated with a two-stage procedure with cement static spacer with antibiotic. We evaluated 33 total knee arthroplasties in 32 patients, with an average age of 69 years and an average postoperative follow-up of 3.5 years.ResultsHealing was achieved in 30 (91%) of the 33 knees. Twenty-eight knees were successfully reimplanted, two with healing infection were not reimplanted for different reasons and 3 had persistent infection. The 28 reimplanted knees evolved favorably, achieving a range of motion of 90º in an average of 3 months after surgery.ConclusionsThe static knee spacer achieved a similar healing rate to that obtained with articulated spacers. The advantage of static spacers is its easy manufacture and placement, giving greater stability and an acceptable range of motion.
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How to Cite
Pesciallo, C. Ángel, Garabano, G., & del Sel, H. (2015). Static cement spacers in total knee infection. Custom manufacturing technique and postoperative motion. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(2), 94-103. https://doi.org/10.15417/36
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Clinical Research
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References
1. Blom AW, Brown J, Tailor HA. Infection after total knee arthroplasty. J Bone Joint Surg Br 2004;86:688-94.
2. Hofmann AA, Kane K, Camargo MP. Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop
Relat Res 1995;321:45-54.
3. Hofmann AA, Goldberg T, Kurtin SM. Treatment of infected TKA using an articulating spacer. Clin Orthop Relat Res
2005;430:125-31.
4. Burnett RS, Kelly MA, Hanssen AD. Technique and timing of two-stage exchange for infection in TKA. Clin Orthop 2007;464:164-9.
5. Jacobs C, Christensen CP, Berend ME. Static and mobile antibiotic-impregnated cement spacer for the management of
prosthetic joint infection. J Am Acad Orthop Surg 2009;17:356-62.
6. Segawa H, Tsukayama DT, Kyle RF. Infection after total knee arthroplasty. J Bone Joint Surg Am 1999;81:1434-9.
7. Insall JN, Thopmson FM, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint
Surg Am 1983;65:1087-92.
8. Garvin KL, Hanssen AD. Infection after total hip arthroplasty: past, present and future. J Bone Joint Surg Am 1995;77:1576-85.
9. Cuckler JM. The infected total knee. Management options. J Arthroplasty 2005;20:33-8.
10. Fang-Yao Chiu, Chien-Fu Jeff Lin. Antibiotic-impregnated cement in revision total knee arthroplasty. J Bone Joint Surg Am
2009;91:628-33.
11. Lombardi AV, Berend KR, Adams JB. Articulating antibiotic spacer: the standard of care for an infected total knee arthroplasty.
Orthopedics 2007;30:782.
12. Murray WR. Use of antibiotic-containing bone cement. Clin Orthop 1984;190:89-96.
13. Rivarola HF, Galli M, Autorino CM. Diagnóstico de infección en la artroplastia total de rodilla. Rev Asoc Argent Ortop
Traumatol 2009;74:2:167-73.
14. Villa T, Carnelli D. Experimental evaluation of the biomechanical performances of a PMMA-based knee spacer. The Knee
2007;14:145-51.
15. Haddad FS, Masri BA, Duncan CP. The PROSTALAC functional spacer in two-stage revision for infected knee replacements.
J Bone Joint Surg Br 2000;82:807-12.
16. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint
Surg Am 2005;87:1746-54.
17. Callaghan JJ, Katz RP, Johnson RC. One-stage revision surgery of the infected hip. Clin Orthop 1999;369:139-45.
18. Goldman RT, Scuderi GR, Insall JN. Two-stage reimplantation for infected total knee replacement. Clin Orthop 1996;331: 118-25.
19. Haleem AA, Berry DJ, Hanssen AD. Mild-term to long-term followup of two stage reimplantation for infected total knee
arthroplasty. Clin Orthop 2004;428:35-40.
20. Masri BA, Duncan CP, Beauchamp CP. Long-term elution of antibiotics from bone-cement. J Arthroplasty 1998;13:331-9.
21. Meek RM, Masri BA, Dunlop D. Patients satisfaction and functional status after treatment of infection at the site of a total knee
arthroplasty with use of the Prostalac articulating spacer. J Bone Joint Surg Am 2003;85:1888-95.
22. Hanssen AD, Rand JA, Osmon DR. Evaluation and treatment of infection at the site of a total knee arthroplasty. Instr Course
Lect 1999;48:111-7.
23. Hsu YC, Cheng HC, Chiu KY. Antibiotic-loaded cement articulating spacer for 2-stage reimplantation in infected total knee
arthroplasty. J Arthroplasty 2007;22:1060-7.
24. Cui Q, Mihalko W, Shields J. Antibiotic-impregnated cement spacer for the treatment of infection associated with total hip or
knee arthroplasty. J Bone Joint Surg Am 2007;89:871-8.
25. Dubhakula SM, Czajka J, Uhl RL. Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected TKA.
J Arthroplasty 2004;19:768-74.
26. Fehring TK, Odum S, Mason JB. Articulating versus static spacer in revision TKA for sepsis. Clin Orthop Relat Res 2000;380:9-16.
27. Emerson RH, Muncie M, Higgins L. Comparison of static with a mobile spacer in total knee infection. Clin Orthop Relat Res
2002;404:132-8.
28. Springer BD, Osmon D, Hanssen AD, Jacofsky DJ. Systemic safety of high dose antibiotic loaded cement spacer after
resection of an infected TKA. Clin Orthop Relat Res 2004;427:47-51.
29. Booth RE, Lotke PA. The result of spacer block technique in revision of infected TKA. Clin Orthop Relat Res 1989;248:57-60
2. Hofmann AA, Kane K, Camargo MP. Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop
Relat Res 1995;321:45-54.
3. Hofmann AA, Goldberg T, Kurtin SM. Treatment of infected TKA using an articulating spacer. Clin Orthop Relat Res
2005;430:125-31.
4. Burnett RS, Kelly MA, Hanssen AD. Technique and timing of two-stage exchange for infection in TKA. Clin Orthop 2007;464:164-9.
5. Jacobs C, Christensen CP, Berend ME. Static and mobile antibiotic-impregnated cement spacer for the management of
prosthetic joint infection. J Am Acad Orthop Surg 2009;17:356-62.
6. Segawa H, Tsukayama DT, Kyle RF. Infection after total knee arthroplasty. J Bone Joint Surg Am 1999;81:1434-9.
7. Insall JN, Thopmson FM, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint
Surg Am 1983;65:1087-92.
8. Garvin KL, Hanssen AD. Infection after total hip arthroplasty: past, present and future. J Bone Joint Surg Am 1995;77:1576-85.
9. Cuckler JM. The infected total knee. Management options. J Arthroplasty 2005;20:33-8.
10. Fang-Yao Chiu, Chien-Fu Jeff Lin. Antibiotic-impregnated cement in revision total knee arthroplasty. J Bone Joint Surg Am
2009;91:628-33.
11. Lombardi AV, Berend KR, Adams JB. Articulating antibiotic spacer: the standard of care for an infected total knee arthroplasty.
Orthopedics 2007;30:782.
12. Murray WR. Use of antibiotic-containing bone cement. Clin Orthop 1984;190:89-96.
13. Rivarola HF, Galli M, Autorino CM. Diagnóstico de infección en la artroplastia total de rodilla. Rev Asoc Argent Ortop
Traumatol 2009;74:2:167-73.
14. Villa T, Carnelli D. Experimental evaluation of the biomechanical performances of a PMMA-based knee spacer. The Knee
2007;14:145-51.
15. Haddad FS, Masri BA, Duncan CP. The PROSTALAC functional spacer in two-stage revision for infected knee replacements.
J Bone Joint Surg Br 2000;82:807-12.
16. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint
Surg Am 2005;87:1746-54.
17. Callaghan JJ, Katz RP, Johnson RC. One-stage revision surgery of the infected hip. Clin Orthop 1999;369:139-45.
18. Goldman RT, Scuderi GR, Insall JN. Two-stage reimplantation for infected total knee replacement. Clin Orthop 1996;331: 118-25.
19. Haleem AA, Berry DJ, Hanssen AD. Mild-term to long-term followup of two stage reimplantation for infected total knee
arthroplasty. Clin Orthop 2004;428:35-40.
20. Masri BA, Duncan CP, Beauchamp CP. Long-term elution of antibiotics from bone-cement. J Arthroplasty 1998;13:331-9.
21. Meek RM, Masri BA, Dunlop D. Patients satisfaction and functional status after treatment of infection at the site of a total knee
arthroplasty with use of the Prostalac articulating spacer. J Bone Joint Surg Am 2003;85:1888-95.
22. Hanssen AD, Rand JA, Osmon DR. Evaluation and treatment of infection at the site of a total knee arthroplasty. Instr Course
Lect 1999;48:111-7.
23. Hsu YC, Cheng HC, Chiu KY. Antibiotic-loaded cement articulating spacer for 2-stage reimplantation in infected total knee
arthroplasty. J Arthroplasty 2007;22:1060-7.
24. Cui Q, Mihalko W, Shields J. Antibiotic-impregnated cement spacer for the treatment of infection associated with total hip or
knee arthroplasty. J Bone Joint Surg Am 2007;89:871-8.
25. Dubhakula SM, Czajka J, Uhl RL. Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected TKA.
J Arthroplasty 2004;19:768-74.
26. Fehring TK, Odum S, Mason JB. Articulating versus static spacer in revision TKA for sepsis. Clin Orthop Relat Res 2000;380:9-16.
27. Emerson RH, Muncie M, Higgins L. Comparison of static with a mobile spacer in total knee infection. Clin Orthop Relat Res
2002;404:132-8.
28. Springer BD, Osmon D, Hanssen AD, Jacofsky DJ. Systemic safety of high dose antibiotic loaded cement spacer after
resection of an infected TKA. Clin Orthop Relat Res 2004;427:47-51.
29. Booth RE, Lotke PA. The result of spacer block technique in revision of infected TKA. Clin Orthop Relat Res 1989;248:57-60