Articulating spacer in the two-stage revision for severe infected knee arthroplasty

Abstract

Objective To investigate the efficiency and safety of articulating spacer for severe infected knee arthroplasty in patients with medical comorbidities and local sinus tracts. Methods Ten consecutive patients with medical comorbidities (rheumatoid arthritis, diabetes mellitus, etc) or local sinus tracts,who were complicated with late infected TKA, were included in the study. All the patients underwent twostage revision using articulating spacers. All of the patients were debridement thoroughly and followed by implantation of an antibiotic-loaded cement articulated spacer. Two-stage revisions were not followed untill the infection were controlled. The hospital for special surgery (HSS) knee scoring system and range of motion were used to evaluate the outcomes. Results One patient underwent knee fusion because the infection was not controlled after first-stage surgery. The other 9 patients had no evidence of infection. The mean follow-up was 50 months (range, 24-90 months), no recurrent infection developed for these 9 patients. The mean modified HSS score had improved from 48 points (range, 32-63) before the resection surgery to 79 points (range,62-91) at the end of the spacer period. At the latest follow-up, the modified HSS score averaged 89 points (range, 74-95). The good and excellent rate was 0, 80% and 100%, respectively. The average range of motion had increased from 13°-70° preoperatively to 8°-93° prior to the revision. And at the latest follow-up, the range of motion averaged 3° to 110°. Conclusion The delayed two-stage revision using an articulating spacer is effective in the treatment of chronically infected TKA characterized by simple, good reproducible, high rate of infection control, better joint function after surgeries Key words: Arthroplasty,replacement,knee; Infection; Prostheses and implants