Complications associated with 133 static, antibiotic-laden spacers after TKA

Faschingbauer, M.; Bieger, Ralf; Reichel, Heiko; Weiner, C.; Kappe, Thomas

doi:10.1007/s00167-015-3646-0

Cited by 34 publications

(39 citation statements)

References 25 publications

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“…Some authors state that static spacers provide greater relief to infected and congested soft tissues, allowing for better eradication of the infection [25]. Others report that these devices cost significantly less than articulating spacers [26].…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

The use of spacers (static and mobile) in infection knee arthroplasty

Mazzucchelli

Rosso

Marmotti

et al. 2015

Curr Rev Musculoskelet Med

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Revision total knee arthroplasty (TKA) is the treatment of choice in patients with periprosthetic joint infection. It may be performed in either a single stage or two stages. In the latter option, between stages, an antibiotic-loaded spacer may be used to maintain a certain amount of joint stability and mobility after the infected implant is removed, adding an intra-articular concentration of antibiotics. There are two types of antibiotic-loaded cement spacers: static and dynamic. Static spacers basically create a temporary arthrodesis with antibiotic-loaded cement and usually are handmade within the surgical field. Dynamic spacers can be created intraoperatively by using different tools or may be prepackaged by the manufacturer; they allow range of motion between stages. In this article, the authors review the indications, surgical techniques, and results for static and dynamic spacers in two-stage revision TKA.

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Section: Indications and Contraindicationsmentioning

confidence: 99%

The use of spacers (static and mobile) in infection knee arthroplasty

Mazzucchelli

Rosso

Marmotti

et al. 2015

Curr Rev Musculoskelet Med

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“…The articulating hip spacers were performed as mould-spacers with an endoskeleton (67%) or as handmade spacers (33%) [ 29 ]. The knee spacers were performed as static, handmade spacers with an endoskeleton [ 30 ]. Two weeks after stopping the systemic antibiotics successful eradication was confirmed by repeat joint aspiration.…”

Section: Methodsmentioning

confidence: 99%

Outcome of Irrigation and Debridement after Failed Two-Stage Reimplantation for Periprosthetic Joint Infection

Faschingbauer

Boettner

Bieger

et al. 2018

BioMed Research International

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Introduction Two-stage revision is the gold standard for the treatment of deep implant infection after knee or hip arthroplasty. Irrigation and debridement may be a treatment option for failed 2-stage revisions in cases where a reinfection occurs within 30 days or the symptoms exist not longer than 3 weeks and is appealing because of its low morbidity. We determined the incidence of recurrent infections following irrigation and debridement for failed two-stage revision hip and knee arthroplasty. Methods We performed a single center retrospective review of periprosthetic hip and knee infections treated with a two-stage procedure from 2002 to 2010. All patients that subsequently underwent irrigation and debridement for a subsequent infection were selected for the current study. Results 440 two-stage revisions were performed between 2002 and 2010. Fifty-one two-stage revisions failed (11.6%). Nineteen failed two-stage revisions were treated with irrigation and debridement; 12 (63.2%) patients remained free of infection at follow-up (mean follow-up: 39 months; range, 24-90 months), infection persisted in 6 patients (31.6%), and 1 patient died (5.3%). Conclusions Success rates of irrigation and debridement for failed two-stage procedures are similar to the success rates of irrigation and debridement in primary implant infections. According to the current paper, irrigation and debridement are an acceptable treatment for acute reinfections after failed two-stage revision if performed within the first 30 postoperative days after failed two-stage procedure or if symptoms are present for less than 3 weeks in the presence of a susceptible organism.

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“…Articulating spacers continue to be used in the clinical setting, but debris from articulating spacers induce changes in CD3, CD20, CD11(c), and IL-17, raising the possibility of associated immune modulation 71 . Static spacers may result in good infection control (94%) 72 , but mechanical spacer-related complications were reported for 15% of 133 static spacers, including restricted range of motion and spacer fracture 73 . Antibiotics used in cement spacers vary, with some studies describing the use of ceftazidime and vancomycin 67 , and others, vancomycin and tobramycin.…”

Section: Shoulder and Elbowmentioning

confidence: 99%