Outcomes of Articulating Spacers With Autoclaved Femoral Components in Total Knee Arthroplasty Infection.

Published

Journal Article

BACKGROUND:In 2-stage revision of total knee arthroplasty (TKA) infection, articulating antibiotic spacers show similar eradication rates and superior range of motion compared with static spacers. This study evaluated infection control and other outcomes in articulating spacers with an autoclaved index femoral component. METHODS:We reviewed 59 patients who underwent 2-stage treatment of TKA infection using articulating antibiotic spacers with an autoclaved femoral component with at least 2-year follow-up (mean: 5.0 years) from spacer placement. Reinfection was defined as any subsequent infection; recurrence was defined as reinfection with the same organism, need for chronic antibiotics, or conversion directly to amputation/arthrodesis. RESULTS:Nine patients (15%) experienced a recurrence and 22 patients (37%) experienced a reinfection. Incidence of diabetes mellitus was significantly higher in patients who became reinfected. Other comorbidities, revision history, prior spacer, or presence of virulent organisms did not predict infection recurrence. Forty-seven spacers underwent reimplantation, 6 (13%) of these went on to above-knee amputation, 6 (13%) received another 2-stage procedure, and 3 (6%) underwent subsequent irrigation and debridement. Three patients (5%) proceeded directly from spacer to above-knee amputation (2) or arthrodesis (1). Nine spacers (15%) in 7 patients were retained indefinitely (mean: 3.4 years), with overall good motion and function. CONCLUSION:Accounting for methodology, articulating spacers with autoclaved femoral components provide similar infection control to previous reports. Most patients with reinfection grew different organisms compared with initial infection, suggesting that some subsequent infections may be host related. Some patients retained spacers definitively with overall good patient satisfaction.

Full Text

Duke Authors

Cited Authors

  • Goltz, DE; Sutter, EG; Bolognesi, MP; Wellman, SS

Published Date

  • August 2018

Published In

Volume / Issue

  • 33 / 8

Start / End Page

  • 2595 - 2604

PubMed ID

  • 29691170

Pubmed Central ID

  • 29691170

Electronic International Standard Serial Number (EISSN)

  • 1532-8406

International Standard Serial Number (ISSN)

  • 0883-5403

Digital Object Identifier (DOI)

  • 10.1016/j.arth.2018.03.059

Language

  • eng