Destination Joint Spacers: A Similar Infection‐Relief Rate But Higher Complication Rate Compared with Two‐Stage Revision

Abstract

Objective To evaluated the clinical outcomes of periprosthetic joint infection (PJI) patients with destination joint spacer compared with that of two‐stage revision. Methods From January 2006 to December 2017, data of PJI patients who underwent implantation with antibiotic‐impregnated cement spacers in our center due to chronic PJI were collected retrospectively. The diagnosis of PJI was based on the American Society for Musculoskeletal Infection (MSIS) criteria for PJI. One of the following must be met for diagnosis of PJI: a sinus tract communicating with the prosthesis; a pathogenis isolated by culture from two separate tissue or fluid samples obtained from the affected prosthetic joint; four of the following six criteria exist: (i) elevated ESR and CRP; (ii) elevate dsynovial fluid white blood cell (WBC) count; (iii) elevated synovial fluid neutrophil percentage (PMN%); (iv) presence of purulence in the affected joint; (v) isolation of a microorganism in one periprosthetic tissue or fluid culture; (vi) more than five neutrophilsper high‐power fields in five high‐power fields observed from histological analysis of periprosthetic tissue at ×400 magnification. Age, sex, body mass index (BMI), and laboratory test results were recorded. All patients were followed up regularly after surgery, the infection‐relief rates were recorded, Harris hip score (HHS) and knee society score (KSS) were used for functional evaluation, a Doppler ultrasonography of the lower limb veins was performed for complication evaluation. The infection‐relief rates and complications were compared between destination joint spacer group and two‐stage revision group. Results A total of 62 patients who were diagnosed with chronic PJI were enrolled, with an age of 65.13 ± 9.94 (39–88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group, namely, two‐stage revision group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group, and this might be the primary reason for joint spacer retainment. As for infection‐relief rate, there were three cases of recurrent infection (14.29%) in the destination joint spacer group and four cases of recurrent infection (9.76%) in the two‐stage revision group, there were no significant differences with regard to infection‐relief rate. Moreover, there two patients who suffered from spacer fractures, three cases of dislocation, one case of a periarticular fracture, and three cases of deep venous thrombosis in destination joint spacer group, while there was only one case of periprosthetic hip joint fracture, one case of dislocation, and one patient suffered from deep venous thrombosis of the lower extremity in two‐stage revision. The incidence of complications in the destination joint spacer group was higher than that of two‐stage revision. Conclusions In summary, the present work showed that a destination joint spacer might be provided as a las...

Mechanical complications of hip spacers: a systematic review of the literature

“…Thirteen studies reported the results of treatments in which a standardized prefabricated spacer was used [ 9 , 11 , 18 , 19 , 23 – 32 ], 5 studies reported on spacers that were intraoperatively produced by means of standardized molds or based on the method of Ivarson et al [ 33 ] (by separately duplicating the shape of the retrieved femoral head and the femoral stem component with bone cement) [ 17 , 31 , 34 – 36 ], 20 studies reported on intraoperatively manually shaped spacers [ 2 , 10 , 14 , 16 , 33 , 37 – 51 ], and two studies presented series in which different types of spacers were used. [ 7 , 15 ] (Table 1 ).…”

Knee Spacers in Periprosthetic Joint Infections: A Narrative Review

“…Metal-on-polyethylene articulating spacers are associated with a lower rate of complications and the absence of spacer fractures (43,44). It is not always possible to have a second stage because of economic and health reasons, and some patients may refuse reimplantation (45). Cai et al suggest using the spacer as a definitive treatment for PJI.…”

The profile of Hip and Knee Periprosthetic Joint Infection cases at Dr. Cipto Mangunkusumo Central National Referral Hospital

“…15 In the second stage of surgery, another opportunity occurs at the point of the reimplantation procedure to ensure contamination is eradicated by intraoperative coreview; histopathology submitted, including frozen sections, sample selection, and spacer removal; and finally, implantation of a new prosthesis because neither procedure was associated with persistent infection. 13,16,17 TSE is the ideal method in determining signs of chronic infection, sinus tract involvement, loose prostheses and other cases of multi-drug resistant infection where antimicrobial options are minimal. TSE is provided also for cases of PJI fungus.…”