Research Article| Volume 27, ISSUE 8, P1474-1479.e1, September 2012

Are Prosthetic Spacers Safe to Use in 2-Stage Treatment for Infected Total Knee Arthroplasty?

Published:April 16, 2012DOI:


      This retrospective study compares treatment results of infected total knee arthroplasty with 2-stage exchange technique using 14 articulating spacers using metallic and polyethylene components (prosthetic group) and 33 static all-cement spacer (static group). For the prosthetic and static groups, treatment success rate was 71% and 67% at 58 months of follow-up, respectively, and not significantly different. The prosthetic group required less frequent extensile surgical approaches at the second-stage reimplantation. Range of motion was significantly improved in both groups, but there was no difference at latest follow-up between the groups. Of 14 in the prosthetic group, 4 (28%) did not undergo second-stage procedure. Antibiotic spacers consisting of prosthetic components can be a safe and effective treatment option for 2-stage revision total knee arthroplasty with equivalent infection control rates.


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        • Windsor R.E.
        • Insall J.N.
        • Urs W.K.
        • et al.
        Two-stage reimplantation for the salvage of total knee arthroplasty complicated by infection. Further follow-up and refinement of indications.
        J Bone Joint Surg Am. 1990; 72: 272
        • Goldman R.T.
        • Scuderi G.R.
        • Insall J.N.
        2-stage reimplantation for infected total knee replacement.
        Clin Orthop Relat Res. 1996; 331: 118
        • Cuckler J.M.
        The infected total knee: management options.
        J Arthroplasty. 2005; 20: 33
        • Hofmann A.A.
        • Goldberg T.
        • Tanner A.M.
        • et al.
        Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience.
        Clin Orthop Relat Res. 2005; 430: 125
        • Hsu Y.C.
        • Cheng H.C.
        • Ng T.P.
        • et al.
        Antibiotic-loaded cement articulating spacer for 2-stage reimplantation in infected total knee arthroplasty: a simple and economic method.
        J Arthroplasty. 2007; 22: 1060
        • Booth Jr., R.E.
        • Lotke P.A.
        The results of spacer block technique in revision of infected total knee arthroplasty.
        Clin Orthop Relat Res. 1989; 248: 57
        • Haleem A.A.
        • Berry D.J.
        • Hanssen A.D.
        Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty.
        Clin Orthop Relat Res. 2004; 428: 35
        • Emerson Jr., R.H.
        • Muncie M.
        • Tarbox T.R.
        • et al.
        Comparison of a static with a mobile spacer in total knee infection.
        Clin Orthop Relat Res. 2002; 404: 132
        • Fehring T.K.
        • Odum S.
        • Calton T.F.
        • et al.
        Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award.
        Clin Orthop Relat Res. 2000; 380: 9
        • Haddad F.S.
        • Masri B.A.
        • Campbell D.
        • et al.
        The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement.
        J Bone Joint Surg Br. 2000; 82: 807
        • Park S.J.
        • Song E.K.
        • Seon J.K.
        • et al.
        Comparison of static and mobile antibiotic-impregnated cement spacers for the treatment of infected total knee arthroplasty.
        Int Orthop. 2010; 34: 1181
        • Meek R.M.
        • Masri B.A.
        • Dunlop D.
        • et al.
        Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer.
        J Bone Joint Surg Am. 2003; 85-A: 1888
        • Hofmann A.A.
        • Kane K.R.
        • Tkach T.K.
        • et al.
        Treatment of infected total knee arthroplasty using an articulating spacer.
        Clin Orthop Relat Res. 1995; 321: 45
        • Anderson J.A.
        • Sculco P.K.
        • Heitkemper S.
        • et al.
        An articulating spacer to treat and mobilize patients with infected total knee arthroplasty.
        J Arthroplasty. 2009; 24: 631
        • Jamsen E.
        • Sheng P.
        • Halonen P.
        • et al.
        Spacer prostheses in two-stage revision of infected knee arthroplasty.
        Int Orthop. 2006; 30: 257
        • Greidanus N.V.
        • Masri B.A.
        • Garbuz D.S.
        • et al.
        Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation.
        J Bone Joint Surg Am. 2007; 89: 1409
        • Parvizi J.
        • Ghanem E.
        • Menashe S.
        • et al.
        Periprosthetic infection: what are the diagnostic challenges?.
        J Bone Joint Surg Am. 2006; 88: 138
        • Trampuz A.
        • Hanssen A.D.
        • Osmon D.R.
        • et al.
        Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection.
        Am J Med. 2004; 117: 556
        • Tsukayama D.T.
        • Estrada R.
        • Gustilo R.B.
        Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections.
        J Bone Joint Surg Am. 1996; 78: 512
        • McPherson E.J.
        • Woodson C.
        • Holtom P.
        • et al.
        Periprosthetic total hip infection: outcomes using a staging system.
        Clin Orthop Relat Res. 2002; 403: 8
        • Jamsen E.
        • Stogiannidis I.
        • Malmivaara A.
        • et al.
        Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach.
        Acta Orthop. 2009; 80: 67
        • Duncan C.P.
        • Beauchamp C.
        A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip.
        Orthop Clin North Am. 1993; 24: 751
        • Pitto R.P.
        • Spika I.A.
        Antibiotic-loaded bone cement spacers in two-stage management of infected total knee arthroplasty.
        Int Orthop. 2004; 28: 129
        • Mortazavi S.M.
        • Vegari D.
        • Ho A.
        • et al.
        Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure.
        Clin Orthop Relat Res. 2011; 469: 3049
        • Sherrell J.C.
        • Fehring T.K.
        • Odum S.
        • et al.
        The Chitranjan Ranawat Award: fate of two-stage reimplantation after failed irrigation and debridement for periprosthetic knee infection.
        Clin Orthop Relat Res. 2011; 469: 18