Two-Stage Revision Using a Modified Articulating Spacer in Infected Total Knee Arthroplasty

Kim, Young Soo; Bae, Ki Cheor; Cho, Chul-Hyun; Lee, Kyung Jae; Sohn, Eun Seok; Kim, Beom Soo

doi:10.5792/ksrr.2013.25.4.180

Cited by 28 publications

(18 citation statements)

References 21 publications

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“…However, the indications for choosing articulating over static spacers remain unclear. In recent reports, it appears articulating spacers offer comparable rates of infection eradication, improved postoperative flexion, and easier surgical exposure when compared with static spacers, albeit at a higher cost and complexity [3,15,20,23], and it has been noted that restoration of ROM is one of the most critical factors associated with patient satisfaction [18]. Importantly, however, some of the supposed benefits of articulating spacers remain unsubstantiated by the available literature at 2-year and greater followup [5].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Lichstein

Hedlund

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Two-stage exchange arthroplasty is a standard approach for treating total knee arthroplasty periprosthetic joint infection in the United States, but whether this should be performed with a static antibiotic spacer or an articulating one that allows range of motion before reimplantation remains controversial. It is unclear if the advantages of articulating spacers (easier surgical exposure during reimplantation and improved postoperative flexion) outweigh the disadvantages of increased cost and complexity in the setting of similar rates of infection eradication. Questions/purposes The purposes of this study were (1) to determine the ultimate range of motion; and (2) to determine the proportion of patients who remained free of infection at a minimum 2 years after treatment with static antibiotic spacers as part of a two-stage revision TKA for the treatment of periprosthetic joint infection. Methods Between 1999 and 2011, we treated 121 patients with chronically infected TKAs, of whom three had medical comorbidities precluding a two-stage exchange, four had died before 2-year followup for reasons other than the surgical intervention, and seven were lost to followup. The remaining 107 patients (109 knees; 53 men and 54 women) were treated using a two-stage approach with static spacers and are evaluated here at a mean of 3.7 years (range, 2.0-9.8 years); no patients were treated with articulating spacers during this study period. Twenty-five percent (27 of 109) of the organisms isolated the first-stage procedure were resistant to methicillin and/or vancomycin. Median age at the time of reimplantation was 67 years (range, 42-89 years). Range of motion was measured by an independent physical therapist with a standard goniometer. Knee Society knee and function scores were calculated before the first stage and at the 2-year mark. Because many of these patients were treated before consensus definitions Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at Stanford University Medical Center, Stanford, CA, USA. of infection were established, we made ...

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Section: Discussionmentioning

confidence: 99%

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Lichstein

Hedlund

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…), flash sterilization may be unavoidable . For a number of decades, the procedure of surgically removing an infected total joint device, flash autoclaving and re‐implanting has been practiced …”

Section: Discussionmentioning

confidence: 99%

“…For example, Chen et al observed a 25% rate of recurring infection in patients who were reimplanted with autoclaved femoral components of a total knee system and static spacers, and a 20% rate of recurring infection in patients who were reimplanted with an autoclaved femoral component and received a mobile spacer . Kim et al noted a 10% rate of recurrent infection in patients who were reimplanted with autoclaved femoral components . Qiu et al reimplanted both tibial and femoral components of a total knee system that were autoclaved and saw 10% rate of infection .…”

Section: Discussionmentioning

confidence: 99%

“…For several decades, it has been common practice during revision surgery to remove an infected implant, flash autoclave (also referred to as immediate‐use steam sterilization or IUSS) and replace the same implant in a patient after irrigation and tissue debridement . Autoclaving is a well‐known and long‐standing practice of sterilization across many fields.…”

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confidence: 99%

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Flash autoclave settings may influence eradication but not presence of well‐established biofilms on orthopaedic implant material

Williams

Taylor

Epperson

et al. 2017

Journal Orthopaedic Research

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Flash autoclaving is one of the most frequently utilized methods of sterilizing devices, implants or other materials. For a number of decades, it has been common practice for surgeons to remove implantable devices, flash autoclave and then reimplant them in a patient. Data have not yet indicated the potential for biofilms to survive or remain on the surface of orthopaedic-relevant materials following flash autoclave. In this study, monomicrobial and polymicrobial biofilms were grown on the surface of clinically relevant titanium materials and exposed to flash autoclave settings that included varying times and temperatures. Data indicated that when the sterilization and control temperatures of an autoclave were the same, biofilms were able to survive flash autoclaving that was performed for a short duration. Higher temperature and increased duration rendered biofilms non-viable, but none of the autoclave settings had the ability to remove or disperse the presence of biofilms from the titanium surfaces. These findings may be beneficial for facilities, clinics, or hospitals to consider if biofilms are suspected to be present on materials or devices, in particular implants that have had associated infection and are considered for re-implantation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1543-1550, 2018.

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“…Previous studies have described good results with the use of an autoclaved femoral component as an articulating spacer 1718). Compared to an NFC spacer, the autoclaved original femoral component is cost-effective11); however, we are concerned about reusing an implant designed for single use only19).…”

Section: Discussionmentioning

confidence: 99%

Use of a New Knee Prosthesis as an Articulating Spacer in Two-Stage Revision of Infected Total Knee Arthroplasty

Juul

Fabrin

Poulsen

et al. 2016

Knee Surg Relat Res

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PurposeTo report our experience with two-stage revision using a new femoral component (NFC) spacer (Depuy Synthes) as an articulating spacer.Materials and MethodsIn this retrospective study, we reviewed 22 two-stage revisions that were performed using an NFC spacer in 22 patients suspected of having an infected total knee arthroplasty (TKA) from December 2010 to March 2013. The result was considered successful when eradication of infection was achieved using only one NFC spacer.ResultsThe average time from primary TKA to the first stage procedure was 29.1 months and the average time from the first stage procedure until the final second stage procedure was 12.7 weeks. The average range of motion increased from 82° preoperatively to 104° postoperatively. The American Knee Society Knee score increased from 29.3 points to 66 points. The Function score increased from 29.5 points to 64 points. Four cases were reinfected after two-stage revision. The mean follow-up was 37.6 months.ConclusionsThe new articulating spacer showed promising short-term results both with regard to eradication of infection and functional improvement.

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Two-Stage Revision Using a Modified Articulating Spacer in Infected Total Knee Arthroplasty

Cited by 28 publications

References 21 publications

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Flash autoclave settings may influence eradication but not presence of well‐established biofilms on orthopaedic implant material

Use of a New Knee Prosthesis as an Articulating Spacer in Two-Stage Revision of Infected Total Knee Arthroplasty

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