Management of Prosthetic Joint Infection following Total Knee Arthroplasty with an Articulating Antibiotic Knee Spacer: An Early Experience

Abstract

Eradication of deep prosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a vexing problem to patients, surgeons, and the health care system. At present, two-stage exchange is a widely accepted method to treat and resolve PJI following TKA. Various spacers are available following resection arthroplasty and are designed for the local delivery of antibiotics and stability of the knee joint. We report our experience with management of PJI in TKA patients with a novel mobile knee spacer. Methods We retrospectively reviewed 31 consecutive infected knee arthroplasties, (primary TKA, 26) and (revision TKA, 5) performed between 2014 and 2016 treated with two-stage exchanges. The outcome of the spacer cohort and subsequent reimplantation procedure was examined to determine spacer range of motion, postoperative range of motion, and reinfection rate following two-stage exchange. Results Minimal spacer-related complications are reported and a stable knee spacer with flexion up to 95° were observed in most patients. The overall mean ± SD time of interim spacer placement for all patients was 25.7± 21.9 weeks (range, 8-109 weeks). The mean ± SD postoperative follow-up (following reimplantation surgery) was 3.52 ± 1.36 years (range, 1.29-6.03 years). Two patients re-infected and required a second two-stage exchange procedure. Following post second stage reimplantation surgery, all patients demonstrated no evidence of recurrence of infection. Conclusions This customized and modular articulating knee spacer has the potential to significantly reduce spacer-related complications following PJI in both primary and revision TKA and provide enhanced stability and improved knee range of motion. Level of Evidence Prognostic Level IV.