Abstract
BackgroundThe aim of this study was to compare the outcomes of static versus articular spacers in two-stage reimplantation for the treatment of infected total knee arthroplasty (TKA).MethodsThe literature regarding the articulating and static spacers for treating infected TKA were searched in PubMed, Embase, Cochrane Library, Chinese Periodical Full-Text Database of CNKI, and Wanfang database. Data were extracted according to the inclusion and exclusion criteria and analyzed by Review Manager 5.3.ResultsTen studies were included to this meta-analysis (nine retrospective studies, one prospective study) according to the principle of PICOS. There was no significant difference regarding the eradication rate (P = 0.28) and the American Knee Society knee score (KSS) pain score (P = 0.11) between the articulating and static spacers in the two-stage revision surgery. There was no significant difference regarding quadriceps femoroplasty and tibial tubercle osteotomy between the two groups (P = 0.50). The knee range of motion (ROM), Hospital for Special Surgery (HSS) score, and KSS function score in the articulating group were significantly higher than those in the static group (P < 0.00001).ConclusionArticulating spacers can provide better ROM and knee function scores after revision surgery when compared to static spacer while not compromising the infection eradication rate, soft tissue contracture during exclusion period, and knee pain scores.
Highlights
The aim of this study was to compare the outcomes of static versus articular spacers in two-stage reimplantation for the treatment of infected total knee arthroplasty (TKA)
All the included literatures were deemed suitable for our inclusion criteria in this meta-analysis
The fixed effect model was used for data analysis, and the results showed that there was no significant difference regarding the eradication rate between the articulating and statics spacers in the twostage revision surgery of postoperative infection after TKA (OR = 1.18, 95% confidence interval (CI): 0.66~2.11, P = 0.59) Fig. 2)
Summary
The aim of this study was to compare the outcomes of static versus articular spacers in two-stage reimplantation for the treatment of infected total knee arthroplasty (TKA). The prosthetic joint infection (PJI) is a devastating and complex complication after total knee arthroplasty (TKA). The static spacers can effectively deliver high concentration of antibiotic to control infection, and maintain the joint space and limb length. Some researchers reported higher risks of complications and the infection rate for the articular bone cement spacers compared to static spacers [13, 14]. There exists controversy regarding which antibiotic spacers are superior in the treatment of infection following total knee arthroplasty. The aim of the present meta-analysis was to compare the clinical outcomes of static spacers with mobile spacers for the treatment of infection following TKA. This paper was conducted in strict accordance with the PICOS principle of formulating the inclusion criteria, and the related literatures were collected and retrieved at home and abroad
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