Long-term results of antibiotic spacers for the infected total knee: A retrospective case-control study

Abstract

Background: Surgery to treat deep space infections in total knee arthroplasty can be associated with significant medical comorbidities. A tibiofemoral intramedullary nail with antibiotic cement (nonarticulating spacers) often is used to eradicate infection while allowing a patient to avoid the potential disadvantages of an above-knee amputation. Methods: A retrospective review of clinical data was performed on all patients treated with a nonarticulating antibiotic spacer from 2010 to 2014. Operative notes, progress reports, laboratory, and microbiology results were collected and analyzed for our cohort of patients. Results: Thirty patients were included within this report of results. The average age was 62.70 yr old (±12.17, min=39, max=86), and the average body mass index was 35.48 (±9.43). Fifty percent were men (15/30), and 56.67% (17/30) of patients had diabetes mellitus. A large portion of patients (20%; 6/30) originally presented to the intensive care unit with septic arthritis and 33.33% (10/30) were septic on arrival. Prior to static spacer placement, 86.67 (26/30) of patients had a previous surgical procedure to attempt to eradicate infection. The average follow-up was 16.82 mo (±12.80 mo), and the most common organism causing the index infection was methicillin-resistant Staphylococcus aureus (MRSA). At final follow-up, 83.33% (15/18) of patients living with a nonarticulating spacer were able to ambulate with the spacer. Conclusions: Nonarticulating antibiotic spacers offer a viable treatment option to stabilize a knee with significant soft-tissue injury and bone loss from explant procedures for infection. Level of Evidence: Level IV.