Two-stage exchange knee arthroplasty: Articulating spacers

Abstract

Infection remains the primary biologic limitation of total knee arthroplasty (TKA), accounting for failure and complication in 1-2 % of total knees implanted (Clin Orthop Relat Res 345:148-54, 1997; J Arthroplasty 25:766-71.e1, 2010; J Arthroplasty 23:984-91, 2008; Clin Orthop Relat Res 468:52-6, 2010; Clin Orthop Relat Res 469:985-93, 2011). The impact on patients and healthcare financing is undeniably harsh, with multiple surgeries and reinfections escalating the morbidity and cost. Despite sporadic reports to the contrary, irrigation and debridement with component retention has yielded inferior infection control (Clin Orthop Relat Res 471:250-7, 2013). Single-staged revision with removal of total knee components and replacement with new, sterile implants remains an attractive option as the patients are not exposed to a second surgery or a delay between surgical stages. The single-stage approach, though an improvement over debridement and retention, has been met with inconsistent success in infection eradication, ranging from 73 to 100 % (Orthopedics 33:659, 2010). Both surgical technique and bacterial speciation likely contribute to this variation and warrant further study.