Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: Good outcome in 30 patients

Abstract

Background and purpose The most reliable results when treating an infected total knee arthroplasty have been obtained with a two-stage reimplantation protocol. We have used a simple technique for hand-made spacers and now report the outcome. Patients and methods 30 patients with an infected total knee arthroplasty (TKA) were treated with a 2-stage reimplantation protocol. Spacers were built and customized to the type of defect using only 2 retractors and a high-speed tip burr. Partial weight bearing and discharge from the hospital were encouraged in the time between surgeries. 29 of 30 patients (97%) had successful reimplantations and they were followed for an aver-age of 3 (2–5) years. Results Range of motion with the articulating spacer averaged 80° (55–100) and 21 of the 30 patients achieved motion greater than 75°. At the latest follow-up, there were no reinfections. According to the Knee Society score (KSS), the results were considered excellent or good in 25 patients, and fair or poor in 4 of the 29 patients with reimplantations. Motion after reimplantation averaged 107° (90–120). Interpretation One of the key factors related to a successful outcome with a two-stage reimplantation pro-cedure is to keep the joint mobile and functional in the time between surgeries. Hand-made articulating spacers retain most of the advantages of more complex spacers in terms of mobility, pain, bone loss, success, or re-infec-tion rate—with the major advantages of price and uni-versal availability. Limitations related to this technique include potential knee instability, the need to walk with an orthosis, and the risk of subluxations.