Comparison of dynamic and static spacers for the treatment of infections following total knee replacement: a systematic review and meta-analysis

Abstract

Background Revision surgery is the most common treatment for patients who develop infection after total knee arthroplasty (TKA). Two types of spacers are often used in revision surgery: dynamic spacers and static spacers. The comparative efficacy of these two types of spacers on knee prosthesis infections is not well established. Therefore, we carried out a systematic evaluation and meta-analysis with the aim of comparing the difference in efficacy between dynamic and static spacers. Methods We conducted the literature search in PubMed, Web of Science, Cochrane Library, and Embase databases. The articles searched were clinical study comparing the difference in efficacy between dynamic spacers and static spacers for the treatment of prosthetic infections occurring after total knee arthroplasty. Results We conducted a literature search and screening based on the principles of PICOS. Ultimately, 14 relevant clinical studies were included in our current study. We use infection control rate as the primary evaluation indicator. The KSS knee scores (KSSs), KSS functional scores, bone loss and range of motion (ROM) are secondary indicators of evaluation. Thirteen of these included studies reported the infection control rates, with no significant difference between dynamic and static shims (RR: 1.03; 95% Cl 0.98, 1.09; P = 0.179 > 0.05). The KSSs were reported in 10 articles (RR: 5.98; 95% CI 0.52, 11.43; P = 0.032 < 0.05). Six articles reported the KSS functional scores (RR: 13.90; 95% CI 4.95, 22.85; P = 0.02 < 0.05). Twelve articles reported the ROM (RR: 17.23. 95% CI 10.18, 24.27; P < 0.0001). Six articles reported the bone loss (RR: 2.04; 95% CI 1.11, 3.77; P = 0.022 < 0.05). Conclusion Current evidence demonstrates that dynamic spacers are comparable to static spacers in controlling prosthetic joint infection. In terms of improving the functional prognosis of the knee joint, dynamic spacers are more effective than static spacers.

The Creation of Articulating Cement Spacer Using Custom-Fabricated Silicone Mold for the Treatment of Periprosthetic Joint Infection: Two Case Reports

“…One of the dreaded complications of arthroplasty surgery is periprosthetic joint infection (PJI) [6][7][8]. The incidence of PJI in the first two years after primary joint replacement ranges from 0.5% to 3%, and revision surgeries show a higher rate of infection, ranging from 2.5% to 4% [1][2][3][4][5][6][7][8][9][10].…”

“…PJI is associated with high rates of mortality and morbidity, adversely affecting the level of mobility and ambulation of patients, thereby reducing the quality of life [1][2][3][4][5][6][7][8][9][10]. Numerous risk factors of PJI have been identified, including advanced age, malnutrition, inflammatory diseases, obesity, diabetes mellitus, and remote infection [1][2].…”

“…Furthermore, good results of single-stage revision require a much more aggressive and complete periarticular tissue resection than two-stage, which many surgeons are not accustomed to performing [11]. As there are numerous variables that may adversely affect the outcome of single-stage revision surgeries, two-stage revision is currently considered the gold standard in the management of PJI [1][2][3][4][5][6][7][8][9][10].…”

“…A temporary cement spacer is imperative in two-stage revision surgery for PJI [9,10]. The temporary cement spacer is inserted after the debridement and removal of the infected primary prosthesis component.…”

“…The temporary cement spacer is inserted after the debridement and removal of the infected primary prosthesis component. On top of its ability to slowly elucidate topical antibiotic, temporary cement spacer also eliminates the dead space left behind by the removal of prosthesis, helping in the eradication of infection and maintaining soft-tissue tension [9,10]. Studies show that static spacers and articulating spacers are comparable in the eradication of infection, but articulating spacers are more superior in providing an improved range of movement of affected joints [9,10].…”