Custom-made Articulating Spacer in Two-stage Revision Total Knee Arthroplasty. An Early Follow-up of 14 Cases of at Least 1 Year after Surgery

Abstract

Total knee replacement (TKR) infection represents only a small percentage of all the potential complications in joint replacement, but one that can lead to disastrous consequences. Two-stage revision, which has been proven to be the most effective technique in eradicating infection, includes prosthesis removal, positioning of an antibiotic-loaded spacer, and systemic antimicrobial therapy for at least 6 weeks. It has been suggested that there is better performance in terms of range of motion, pain, extensor mechanism shortening, and spacer-related bone loss if articulating spacers are used instead of fixed spacers. In this paper, we describe our results in two-stage revision of infected total knee arthroplasty with a minimum follow-up of 12 months on 14 patients treated by antibiotic-loaded custom-made articulating spacer as described by Villanueva et al. (Acta Orthop 77(2):329–332, 2006). The mean flexion achieved after the second stage of the revision was 120°, ranging from 97° to 130°. The mean Hospital for Special Surgery score was 84. At 1 year after surgery, none of the knees showed any evidence of recurrence of the infection. Articulating spacers are a suitable alternative to fixed spacers with good range of motion after reimplantation and effectiveness against total knee replacement deep infections.