Pre-formed articulating knee spacer in two-stage revision for the infected total knee arthroplasty

Abstract

We performed a prospective study to assess safety and effectiveness of a pre-formed articulating spacer made of gentamicin-impregnated acrylic cement in the management of infected total knee arthroplasty. Twentyone consecutive patients with unilateral deep infection were treated by two-stage revision in two centres. Two patients were excluded, and 19 patients remained available for assessment. The mean implantation time of the spacer was 12 weeks. The rehabilitation programme between stages consisted in early range of motion exercises and partial weight bearing. Mean follow-up after removal of the spacer and insertion of the final prosthesis was 24 (range, 12-43) months. No patient had recurrence of infection at the latest follow-up. The mean Knee Society functional score during spacer management was rated 75 points and was rated 84 points at the latest follow-up. No devicerelated complication was observed.

Is There a Preferred Articulating Spacer Technique for Infected Knee Arthroplasty?: A Preliminary Study

“…Given the failure to find a difference in infection control between AOC and NFC techniques and the lower cost of the former, we would still recommend use of the AOC technique where permitted. Cement-on-cement articulating spacers can be prepared intraoperatively using silicone molds or can be hand-made or prefabricated [6,9,11,12,20,27]. They have the advantage of greater surface area for antibiotic elution but are available in limited sizes and have the risk of a cement component fracture and cement debris.…”

“…These were initially hand-made [24], but subsequently silicone molds for intraoperatively fabricating cement components (silicon mold components [SMCs]) have been developed [9,23]. Prefabricated cement spacers are also commercially available [27].…”

Industrially Prefabricated Cement Spacers: Do Vancomycin- and Gentamicin-impregnated Spacers Offer Any Advantage?

“…Subsequently, use of antibiotic-impregnated bone cement spacers during the first stage has been considered the standard of care for patients with a chronic infection at the site of a joint infection [10,19]. There are numerous types of mobile prosthesis-like spacers available [14,25,27,30,36,37], one of which is an industrially preformed antibiotic-loaded cement spacer [25,27]. These spacers are preformed at the factory and loaded with a fixed type and amount of antibiotic.…”

Comparison of static and mobile antibiotic-impregnated cement spacers for the treatment of infected total knee arthroplasty

“…Antibiotic-impregnated cement spacers (AICS) are available as static and mobile types. Static AICS have been used to deliver high doses of antibiotics locally and to minimise contractures of collateral ligaments, thus facilitating second-stage reimplantation [18]. Due to immobilisation between surgical stages, static AICS result in joint stiffness and exposure difficulty at time of reimplantation; accordingly, mobile AICS were developed to solve these problems [13,15].…”