Abstract
BackgroundIn comparison to static spacers, articulating spacers have been shown to result in a similar infection eradication rate in two-stage revision of periprosthetic knee infections. However, the optimal construct for articulating spacers has not been identified yet. The aim of this study was to present a preliminary result of treatment for periprosthetic knee infection using a novel computer-aided design (CAD)-articulating spacer.MethodsWe retrospectively reviewed 32 consecutive cases of chronic periprosthetic knee infection occurring from January 2015 to December 2015. In these cases, we used an antibiotic-loaded, optimized CAD-articulating spacer based on the retrieved knee prosthesis. Evaluation included infection eradication rate, the Hospital of Special Surgery (HSS) knee score, range of motion (ROM), and spacer-related mechanical complications. All cases were regularly followed-up for 2 years minimum.ResultsTwenty-eight of 32 patients (87.5%) had infection eradication; 18 patients (56.3%) received reimplantation successfully. The mean interval between spacer insertion and reimplantation was 8.8 months (range 4.0–12.5 months). The mean HSS knee score and ROM significantly increased during each interval (p < 0.0001 for both). The mean HSS knee scores were 31.2 (range 20–48) at initial visit, 65.4 (range 60–78.8) at 1 month after spacer insertion, and 84.2 (range 78–90) at 3 months after reimplantation (p < 0.0001). The mean ROM were 72.0° (range 15–100°), 85.6° (range 35–110°), and 102.0° (range 80–122°), respectively (p = 0.002). Two (6.3%) spacer-related mechanical complications occurred.ConclusionsThe CAD-articulating spacer in two-staged revision of periprosthetic knee infection significantly controlled infection, improved clinical outcomes, increased ROM, and decreased mechanical complications in the preliminary study. Further larger clinical studies are needed to confirm the findings presented here.
Highlights
In comparison to static spacers, articulating spacers have been shown to result in a similar infection eradication rate in two-stage revision of periprosthetic knee infections
The patient received reimplantation after 5.5 months, without further complications. This was the first preliminary study to fabricate optimized articulating spacers based on retrieved knee prosthesis with reverse engineering, using computer-aided design (CAD) and computer-aided manufacture (CAM) techniques
The preliminary result demonstrated that CAD-articulating spacers in two-staged revision of periprosthetic knee infection could eradicate infection, improve clinical outcomes, increase range of motion (ROM), and decrease mechanical complications
Summary
In comparison to static spacers, articulating spacers have been shown to result in a similar infection eradication rate in two-stage revision of periprosthetic knee infections. Several articulating spacer-related mechanical complications have occurred, such as extensor apparatus problems, spacer loosening or fracture, and joint subluxation or dislocation; as many as 57% of cases have reported these complications [5, 6]. These problems might lead to further surgery, poor functional outcomes, prolonged treatment courses during interim stage, and difficulty in reimplantation [7, 8]
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