Functional Articulating Antibiotic Spacers for Chronic Native Septic Knee Arthritis

Levent A. Ozdemir, BS; Andrew E. Apple, MD; C. Lowry Barnes, MD; Benjamin Stronach, MD; Simon C. Mears, MD, PhD; Jeffrey B. Stambough, MD

Arthroplasty Today (Jun 2024)

Functional Articulating Antibiotic Spacers for Chronic Native Septic Knee Arthritis

Levent A. Ozdemir, BS,
Andrew E. Apple, MD,
C. Lowry Barnes, MD,
Benjamin Stronach, MD,
Simon C. Mears, MD, PhD,
Jeffrey B. Stambough, MD

Affiliations

Levent A. Ozdemir, BS: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Andrew E. Apple, MD: Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA
C. Lowry Barnes, MD: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Benjamin Stronach, MD: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Simon C. Mears, MD, PhD: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Jeffrey B. Stambough, MD: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Corresponding author. Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA. Tel.: +1 501 246 4439.

Journal volume & issue: Vol. 27
p. 101329

Abstract

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Background: Semipermanent functional spacers are now utilized for prosthetic joint infection in an attempt to avoid another surgery with 2-stage treatment. This study evaluates the results of metal-on-polyethylene articulating spacers for the treatment of chronic native septic knee arthritis. Methods: This is a retrospective review of 18 patients treated with metal-on-polyethylene articulating antibiotic spacers constructed with all-polyethylene tibial components or with polyethylene inserts (PIs) with Steinmann pins or screws for chronic native knee infection. Demographic information, spacer construct type, prior knee surgery, complications, infecting organisms, infection eradication, and functional results were analyzed. Results: Of 18, 8 (44%) spacers were all-polyethylene tibial components and 10 (56%) were PI. Of 18 patients, 5 (28%) experienced spacer complications. Of 18 patients, 12 (67%) underwent a second reimplantation surgery (mean 106 days), while 6 (33%) retained their spacer (average duration 425 days). The PI group performed better in Knee Injury and Osteoarthritis Outcome score for Joint Replacement according to minimum clinically important difference and patient acceptable symptom state (PASS) criteria. The overall reimplantation group achieved Knee Injury and Osteoarthritis Outcome score for Joint Replacement PASS criteria and minimum clinically important difference criteria, while the maintained articulating spacer group did not achieve PASS criteria; however, they did reach minimum clinically important difference. Conclusions: Functional articulating spacers are a viable treatment for chronic, native knee septic arthritis. The PI patient group had a greater improvement in Knee Injury and Osteoarthritis Outcome score for Joint Replacement scores and had no significant difference in reimplantation rate as the all-polyethylene tibial components patient group. Both planned 2-stage reimplantation and longer-term spacer retention show promising results for this difficult clinical problem.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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