A "1.5-Stage" Spacer Construct Using Revision Components for the Management of Periprosthetic Joint Infection of the Knee.

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The two-stage surgical protocols used for the treatment of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) are associated with marked patient morbidity. As such, alternatives such as durable "1.5-stage" spacer constructs have gained popularity. We sought to describe the outcomes of a novel "1.5-stage" spacer construct utilizing revision stemmed-tibia implants. Patients who underwent a "1.5-stage" for the management of a knee PJI at our institution were screened for inclusion. A "1.5-stage" was defined as a spacer placed with the intent of not performing a second stage, without the use of press-fit stems or cemented intramedullary fixation as is often done during a single-stage protocol. Procedures were categorized into two groups based on construct type: (1) hand-made constructs utilizing all-polyethylene tibial components or (2) constructs utilizing stemmed-revision components pre-coated with cement before insertion. Patient demographics, comorbidities, and surgical details were collected and reported. The two-year Kaplan-Meier survival estimates for all-cause revision, revision for spacer loosening, and revision due to infection recurrence were reported. In total, 46 "1.5-stage" procedures were identified, including 12 hand-made and 34 stemmed-revision constructs. The stemmed-revision cohort was less likely to undergo reoperation for any reason (17.6 versus 50.0%, P = 0.028) or a revision for spacer loosening (0.0 versus 25.0%, P = 0.003) compared to the hand-made cohort. There were no differences with respect to infection recurrence or time to revision. The 2-year survival from revision for loosening was higher in the stemmed cohort compared to the hand-made cohort, though not statistically different (100%, 95% CI [confidence interval]: 2.5 to 100.0% versus 72.9%, 95% CI: 26.3 to 96.6%, P = 0.330). A "1.5-stage" spacer construct using stemmed-revision components was associated with promising short-term results. Durable spacer constructs may be a viable option for select patients, however; longer-term follow-up is needed to identify patients that stand to benefit the most from this technique.