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A Permanent Articulating Spacer Versus Two-Stage Exchange for Chronic Periprosthetic Joint Infection: A Propensity Score-Matched Study.

Publication ,  Journal Article
Belay, ES; Wixted, CM; Kim, BI; Wellman, SS; Jiranek, WA; Bolognesi, MP; Seyler, TM
Published in: J Arthroplasty
August 2023

BACKGROUND: Although 2-stage revision has been proposed as gold standard for periprosthetic joint infection treatment, limited evidence exists for the role of articulating spacers as definitive management. The purpose of this study was to compare clinical outcomes and costs associated with articulating spacers (1.5-stage) and a matched 2-stage cohort. METHODS: A retrospective review was performed for patients who had chronic periprosthetic joint infections after total knee arthroplasty defined by Musculoskeletal Infection Society criteria and were matched via propensity score matching using cumulative Musculoskeletal Infection Society scores and a comorbidity index. Patients who maintained an articulating spacer (cemented cobalt-chrome femoral component and all-poly tibia) were included in the 1.5-stage cohort. Patients who underwent a 2-stage reimplantation procedure were included in the 2-stage cohort. Outcomes included visual analog scale pain scores, 90-day emergency department visits, 90-day readmission, unplanned reoperation, reinfection, as well as cost at 1 and 2-year intervals. A total of 116 patients were included for analyses. RESULTS: The 90-day pain scores were lower in the 1.5-stage cohort compared to the 2-stage cohort (2.9 versus 4.6, P = .0001). There were no significant differences between readmission and reoperation rates. Infection clearance was equivalent at 79.3% for both groups. Two-stage exchange demonstrated an increased cost difference of $26,346 compared to 1.5-stage through 2 years (P = .0001). Regression analyses found 2 culture-positive results with the same organism decreased the risk for reinfection [odds ratio: 0.2, 95% confidence interval 0.04-0.8, P = .03]. CONCLUSION: For high-risk candidates, articulating spacers can preserve knee function, reduce morbidity from second-stage surgery, and lower the costs with similar rates of infection clearance as 2-stage exchange. LEVEL OF EVIDENCE: Level III, therapeutic study.

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Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

August 2023

Volume

38

Issue

8

Start / End Page

1584 / 1590

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Reinfection
  • Prosthesis-Related Infections
  • Propensity Score
  • Pain
  • Orthopedics
  • Humans
  • Arthritis, Infectious
  • Anti-Bacterial Agents
  • 4003 Biomedical engineering
 

Citation

APA
Chicago
ICMJE
MLA
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Belay, E. S., Wixted, C. M., Kim, B. I., Wellman, S. S., Jiranek, W. A., Bolognesi, M. P., & Seyler, T. M. (2023). A Permanent Articulating Spacer Versus Two-Stage Exchange for Chronic Periprosthetic Joint Infection: A Propensity Score-Matched Study. J Arthroplasty, 38(8), 1584–1590. https://doi.org/10.1016/j.arth.2023.01.036
Belay, Elshaday S., Colleen M. Wixted, Billy I. Kim, Samuel S. Wellman, William A. Jiranek, Michael P. Bolognesi, and Thorsten M. Seyler. “A Permanent Articulating Spacer Versus Two-Stage Exchange for Chronic Periprosthetic Joint Infection: A Propensity Score-Matched Study.J Arthroplasty 38, no. 8 (August 2023): 1584–90. https://doi.org/10.1016/j.arth.2023.01.036.
Belay ES, Wixted CM, Kim BI, Wellman SS, Jiranek WA, Bolognesi MP, et al. A Permanent Articulating Spacer Versus Two-Stage Exchange for Chronic Periprosthetic Joint Infection: A Propensity Score-Matched Study. J Arthroplasty. 2023 Aug;38(8):1584–90.
Belay, Elshaday S., et al. “A Permanent Articulating Spacer Versus Two-Stage Exchange for Chronic Periprosthetic Joint Infection: A Propensity Score-Matched Study.J Arthroplasty, vol. 38, no. 8, Aug. 2023, pp. 1584–90. Pubmed, doi:10.1016/j.arth.2023.01.036.
Belay ES, Wixted CM, Kim BI, Wellman SS, Jiranek WA, Bolognesi MP, Seyler TM. A Permanent Articulating Spacer Versus Two-Stage Exchange for Chronic Periprosthetic Joint Infection: A Propensity Score-Matched Study. J Arthroplasty. 2023 Aug;38(8):1584–1590.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

August 2023

Volume

38

Issue

8

Start / End Page

1584 / 1590

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Reinfection
  • Prosthesis-Related Infections
  • Propensity Score
  • Pain
  • Orthopedics
  • Humans
  • Arthritis, Infectious
  • Anti-Bacterial Agents
  • 4003 Biomedical engineering