Does spiked tibial cement spacer reduce spacer-related problems in two-stage revision total knee arthroplasty for infection?

Jung, Kwang-Hwan; Lee, Chae-Chil; Kim, Tae-Hoon; Han, Ji-Won; Park, Ki-Bong

doi:10.1007/s00264-022-05438-6

Cited by 4 publications

(1 citation statement)

References 18 publications

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“…In revision TKA, Oh et al reported that metaphyseal fixation is important for ensuring the stability of the component [36]; Lee et al recommended the use of an extension stem with a tibial canal filling ratio > 0.85 to minimize tibial component loosening [37]. Jung et al reported that the spiked bottom of the tibial spacer provides superior stability and lowers spacer translation and tilting than a flat bottom [38]. Tsai et al used the bottom of a tibial spacer with a cement stem extension to fill the metaphyseal defect and stably implant a spacer to minimize spacer loosening and migration [17].…”

Section: Discussionmentioning

confidence: 99%

Effect of Surgeon Volume on Mechanical Complications after Resection Arthroplasty with Articulating Spacer

Ko,

Tsai,

Fong

et al. 2024

JPM

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Two-stage revision with an antibiotic-loaded cement articulating spacer is a standard treatment for chronic prosthetic knee infection (PKI); however, mechanical complications can occur during the spacer period. There is limited evidence on the association between surgeon volume and mechanical complications after resection arthroplasty (RA) using an articulating spacer. This study aimed to compare the rates of mechanical complications and reoperation after RA with articulating spacers by surgeons with high volumes (HV) and low volumes (LV) of RA performed and analyzed the risk factors for mechanical failure. The retrospective study investigated 203 patients treated with PKIs who underwent RA with articulating spacers and were divided according to the number of RAs performed by the surgeons: HV (≥14 RAs/year) or LV (<14 RAs/year). Rates of mechanical complications and reoperations were compared. Risk factors for mechanical complications were analyzed. Of the 203 patients, 105 and 98 were treated by two HV and six LV surgeons, respectively. The mechanical complication rate was lower in HV surgeons (3.8%) than in LV surgeons (36.7%) (p < 0.001). The reoperation rate for mechanical complications was lower in HV surgeons (0.9%) than in LV surgeons (24.5%) (p < 0.001). Additionally, 47.2% of patients required hinge knees after mechanical spacer failure. Medial proximal tibial angle < 87°, recurvatum angle > 5°, and the use of a tibial spacer without a cement stem extension were risk factors for mechanical complications. Based on these findings, we made the following three conclusions: (1) HV surgeons had a lower rate of mechanical complications and reoperation than LV surgeons; (2) mechanical complications increased the level of constraint in final revision knee arthroplasty; and (3) all surgeons should avoid tibial spacer varus malalignment and recurvatum deformity and always use a cement stem extension with a tibial spacer.

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Section: Discussionmentioning

confidence: 99%

Effect of Surgeon Volume on Mechanical Complications after Resection Arthroplasty with Articulating Spacer

Ko,

Tsai,

Fong

et al. 2024

JPM

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Clinical outcomes of two-stage revision arthroplasty using a spiked tibial cement spacer in infected total knee arthroplasty

Park,

Kim,

Lee

et al. 2024

International Orthopaedics (SICOT)

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Purpose A tibial cement spacer (TCS) with spikes offers better initial stability than a conventional TCS and reduces spacer-related problems in two-stage revision total knee arthroplasty (R-TKA) for infection. We compared the clinical outcomes of two-stage revision arthroplasty for infected TKA using spiked TCS with that of conventional TCS. Methods This retrospective cohort study included 29 patients who underwent two-stage revision arthroplasty using an articulating cement spacer and who could be followed up for at least one year. Group S comprised 14 patients using spiked TCS, whereas Group C comprised 15 patients using conventional TCS. Demographic data, the interval from first to second stage revision, motion arc, numerical rating scale (NRS), Knee Society (KS) score, serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and frequency of repeating the first-stage and infection recurrence after R-TKA between the groups were analyzed. Results No significant differences were observed in the female ratio and mean age between both groups. The mean interval between the first and second stage revision was significantly shorter in Group S than in Group C. The mean motion arc was significantly larger in Group S than in Group C. The mean NRS was significantly lower in Group S than in Group C. The mean KS score in Group S was significantly higher than that in Group C. Serum ESR and CRP levels did not differ between the groups. The frequency of repeating the first stage was lower in Group S than in Group C. However, the recurrence rate after R-TKA was higher in Group S than in Group C. Conclusion Compared with conventional TCS, spiked TCS shortened the period until R-TKA and improved pain and function levels. However, no significant difference existed in the rate of infection recurrence after R-TKA.

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Letter to the editor regarding the article: “Clinical outcomes of two-stage revision arthroplasty using a spiked tibial cement spacer in infected total knee arthroplasty”

Yu,

2024

International Orthopaedics (SICOT)

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Does spiked tibial cement spacer reduce spacer-related problems in two-stage revision total knee arthroplasty for infection?

Cited by 4 publications

References 18 publications

Effect of Surgeon Volume on Mechanical Complications after Resection Arthroplasty with Articulating Spacer

Effect of Surgeon Volume on Mechanical Complications after Resection Arthroplasty with Articulating Spacer

Clinical outcomes of two-stage revision arthroplasty using a spiked tibial cement spacer in infected total knee arthroplasty

Letter to the editor regarding the article: “Clinical outcomes of two-stage revision arthroplasty using a spiked tibial cement spacer in infected total knee arthroplasty”

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