Two-Stage Treatment for Total Knee Arthroplasty Infection Utilizing an Articulating Prefabricated Antibiotic Spacer

Warth, Lucian C.; Hadley, Christopher J.; Grossman, Eric L

doi:10.1016/j.arth.2019.10.049

Cited by 25 publications

(24 citation statements)

References 20 publications

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“…Antibiotic-loaded cement spacers have become an established method for infection control. The use of high-dose antibiotic-loaded cement as a temporary joint spacer seems to increase the potential for local infection eradication during the time between implant removal and before the second-stage surgery, which aims to restore function and mobility by the use of knee arthroplasty implants once again [3,18,19]. While two-stage revision is still considered to be the gold standard in the treatment of PJI, especially in the United States, there is growing popularity for the one-stage approach [13,20,21].…”

Section: Discussionmentioning

confidence: 99%

“…International Publisher 80-90%, there are still cases where this method fails [3]. There are several possible explanations.…”

Section: Ivyspringmentioning

confidence: 99%

“…First, there are marked differences regarding individual circumstances (resistant or difficult to treat microorganisms, worse local and general conditions). Second, the treatment protocol for two-stage exchange arthroplasty may vary depending on geographic and/or empiric experiences of the treating department [2][3][4][5][6][7]. For example, to our knowledge there are no specific recommendations concerning the length of joint-spacer retention [1,3,[8][9].…”

Section: Ivyspringmentioning

confidence: 99%

“…However, the optimal spacer retention period remains unclear, although several reports have suggested an interval of 6 weeks. In our series, first-stage surgery was followed by an interval of systemic antibiotic administration (usually 6-8 weeks, as recommended in the literature) until the infection was clinically eradicated before the second procedure was performed [3,12,13,14].…”

Section: Spacer Retention Periodmentioning

confidence: 99%

“…Despite continuous innovations and improvements in knee arthroplasty, the occurrence of prosthetic joint infections (PJI) has not decreased. Although the overall PJI incidence following total knee arthroplasty is low (1-2%), PJI represents a serious complication with potentially devastating effects to the patients [1][2][3]. Two-stage exchange arthroplasty has been the procedure of choice for chronic infections.…”

Section: Introductionmentioning

confidence: 99%

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Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

Vielgut¹,

Schwantzer²,

Leithner³

et al. 2021

Int. J. Med. Sci.

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Background: Periprosthetic joint infection (PJI) represents a serious complication following total knee arthroplasty. In the setting of chronic infections, the two-staged approach has traditionally been the preferred treatment method. The aim of this study was to determine the optimal period of rest between the first and second stage. Furthermore, we analyzed potentially outcome-relevant parameters, such as general and local conditions and the presence of difficult-to-treat or unidentified microorganisms, with regard to their impact on successful treatment of PJI. Patients and Methods: We performed a retrospective analysis of prospectively collected data for all patients treated for PJI at our institution. Seventy-seven patients who had undergone two-stage revision arthroplasty for PJI of the knee were included into the study. Antibiotic-loaded cement spacers were used for all patients. Results: After a median follow-up time of 24.5 months, infection had reoccurred in 14 (18.7%) patients. A prolonged spacer-retention period of more than 83 days was related to a significantly higher proportion of reinfections. Furthermore, significant compromising local conditions of the prosthetic tissue and surrounding skin, as well as repeated spacer-exchanges between first-and second-stage surgery, negatively influenced the outcome. Neither the patients' age nor gender exerted a significant influence on the outcome regarding reinfection rates for patients' age or gender. Conclusions: We observed the best outcome regarding infection control in patients who had undergone second-stage surgery within 12 weeks after first-stage surgery. Nearly 90% of these patients stayed free from infection until the final follow-up. An increased number of performed spacer-exchanges and a bad local extremity grade also had a negative impact on the outcome.

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Section: Discussionmentioning

confidence: 99%

“…International Publisher 80-90%, there are still cases where this method fails [3]. There are several possible explanations.…”

Section: Ivyspringmentioning

confidence: 99%

Section: Ivyspringmentioning

confidence: 99%

Section: Spacer Retention Periodmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

Vielgut¹,

Schwantzer²,

Leithner³

et al. 2021

Int. J. Med. Sci.

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Periprothetische Früh- und Spätinfektionen

2020

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

Jung

Lee

Kim

et al. 2022

International Orthopaedics (SICOT)

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Purpose Articulating cement spacers are frequently used in staged approaches for infected total knee arthroplasty (TKA). This study investigated whether a tibial cement spacer (TCS) with spikes could reduce spacer-related problems in two-stage revision TKA (R-TKA). Methods A total of 27 patients (27 knees; 10 men and 17 women) who underwent two-stage R-TKA for infected TKA were retrospectively analyzed. Group A comprised 12 patients who used TCS with spikes added to the bottom surface, whereas group B consisted of 15 patients who used conventional TCS with a flat bottom. For each group, plain radiographs were obtained after cement spacer implantation and before R-TKA to measure mediolateral (ML) translation and TCS’s tilting angle. Patients’ demographic data, ML translation of the TCS, and changes in the TCS’s tilting angle between the groups were analyzed. Results The mean ML translation was significantly lower in group A than that in group B (1.7 mm vs. 5.4 mm, p = 0.04). The mean change in the tilting angle was significantly lower in group A than that in group B (4.5° vs. 19.4°, p = 0.047). Conclusion The spiked TCS in two-stage R-TKA provides superior stability compared to the TCS with a conventional design.

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Two-Stage Treatment for Total Knee Arthroplasty Infection Utilizing an Articulating Prefabricated Antibiotic Spacer

Cited by 25 publications

References 20 publications

Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

Successful Two-Stage Exchange Arthroplasty for Periprosthetic Infection Following Total Knee Arthroplasty: The Impact of Timing on Eradication of Infection

Periprothetische Früh- und Spätinfektionen

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

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