Minimizing Dynamic Knee Spacer Complications in Infected Revision Arthroplasty

Johnson, Aaron J.; Sayeed, Siraj A.; Naziri, Qais; Khanuja, Harpal S.; Mont, Michael A.

doi:10.1007/s11999-011-2095-4

Cited by 58 publications

(69 citation statements)

References 36 publications

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“…Of the four case series with over 100 patients’ reinfection rates were 7% [51], 13% [35], 17% [44] and 28% [54]. Each of these four studies were published between 2011 and 2012.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

Masters

Smith

Foguet

et al. 2013

BMC Musculoskelet Disord

123

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BackgroundPeriprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates.MethodsA systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded.Results63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies.ConclusionsEvidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority.

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“…Of the four case series with over 100 patients’ reinfection rates were 7% [51], 13% [35], 17% [44] and 28% [54]. Each of these four studies were published between 2011 and 2012.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

Masters

Smith

Foguet

et al. 2013

BMC Musculoskelet Disord

123

View full text Add to dashboard Cite

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“…The indications for the revision procedure included second-stage revision for the treatment of deep infection (22 knees), aseptic loosening (19), severe osteolysis (7), pain (4), severe knee instability (3), extensor mechanism problems (3) and wear (2). The median time from the primary knee replacement to revision was 29 months (range, four to 75).…”

Section: Methodsmentioning

confidence: 99%

“…More than 350,000 primary knee arthroplasties were performed in the United States in 2002, and about 29,000 knee revisions [1], with 46,000 during 2005 alone [2]. It has been estimated that by 2030, every year, 500,000 Americans aged 65 or over will undergo total knee arthroplasty (TKA) [3].…”

Section: Introductionmentioning

confidence: 99%

Constraint choice in revision knee arthroplasty

Vasso

Beaufils

Panni

2013

International Orthopaedics (SICOT)

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Purpose Along with the increase in primary total knee arthroplasty, there has been an increase in the number of revisions. The aim of this study was to propose a selection algorithm for the knee revision constraint according to the state of ligaments and to the bone defects Anderson Orthopaedic Research Institute Classification [AORI] classification. The hypothesis was that this algorithm would facilitate the appropriate choice of prosthesis constraint, thus providing stable components and a good long-term survivorship of the knee revisions. Methods Sixty consecutive revision knee arthroplasties in 57 patients were prospectively evaluated. Prostheses implanted at revision included postero-stabilised, condylar constrained and rotating hinged, relative to the state of the ligaments and of the bone loss around the knee. The median follow-up was nine years (range, 4-12). Results The median IKS knee and function scores and HSS score were 41 (15-62), 21.5 (12-43) and 34 (23-65) points, respectively, before the operation, and 81 (48-97), 79 (56-92) and 83.5 (62-98) points (p<0.001) at the latest followup evaluation. The median ROM increased from 74°(29-110°) preoperatively to 121°(98-132°) (p<0.01) at the final follow-up. Re-revision was necessary in five (8.3 %) patients. Conclusions A selection algorithm for the revision implant constraint based on the state of ligaments and the bone loss AORI classification could provide stable knee reconstructions and long-term success of knee revisions.

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“…First, it has been demonstrated that up to about one third of infectious processes of the knee are expanded along the intramedullary femoral and tibial canals; therefore, placing a cemented intramedullary stem may help control the infection at this level [48•]. Second, in some cases, the lack of a stem may lead to dislocation of the components, eventually leading to wound and vascular problems [49].…”

Section: Cement-on-cement Interface: Molded or Preformed Spacersmentioning

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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Minimizing Dynamic Knee Spacer Complications in Infected Revision Arthroplasty

Abstract: Reinfection rates, Knee Society scores, and ROM were comparable between the static and dynamic spacer groups. Meticulous surgical technique and proper patient selection should be used to avoid any complications with any spacers.

Cited by 58 publications

References 36 publications

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

Constraint choice in revision knee arthroplasty

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

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